RENAL ALLOTRANSPLANTATION IN CHILDHOOD

REVIEW OF THE LITERATURE AND REPORT OF A SIX-YEAR SURVIVAL

Abstract

The first patient of pediatric renal allotransplantation in Japan was presented. The patient received a renal allograft at the age of 10 years from his older brother. Following transplantation, he was treated with azathioprine, prednisolone, and local irradiation. On the sixth postoperative day urinary extravation became evident and the ureteropelvic anastomosis was explored, with the vesicoureteral splint exiting through the bladder wall. Leakage continued. Twenty days after transplantation the recipient ureter was rejoined to the ureteropelvic juncture. Chronic urinary drainage continued. Pyeloileocy-stostomy was successfully performed 308 days after the transplantation. There were no acute rejection episodes. He led a normal, active life. He finished primary and junior high schools, and went on to senior high school. In the 5th year after the transplantation the serum creatinine began to rise. Deteriorating renal function did not respond to increased steroid doses. Five years and 10 months after the transplantation the patient developed generalized infections. Renal function deteriorated rapidly over the next two weeks. Hemodialysis was reinstituted and the kidney was removed. The patient died of generalized infections 2, 166 days after the transplantation.