Abstract
Only about 25% of children on PD in Japan receive renal transplants, while the pediatric dialysis population is steadily increasing. We evaluated various factors which affect the choice of renal transplantation in children, classifying them into two groups; donor and recipient factors. From 1984 to 1994, 34 children (≤15 years old) started dialysis in our hospital, of which 13 (38%) received live donor transplants (transplant group) and 21 (62%) did not receive transplants (dialysis group). There were no significant differences between the two groups in mean age, male/female ratio, age at the start of dialysis, dialysis periods, cause of ESRD or dialysis modalities. Nine (26%) patients transferred to other dialysis centers near their home, but none of these centers had a Department of Pediatrics. All patients who received transplants were from our hospital. The donor factors included a) medical problems, death, older age or unwillingness for transplants, b) ABO blood group incompatibility and c) two fraternal recipients for one donor and were observed in 71% of the dialysis group, but were not observed at all in the transplant group. The recipient factors including a) FSGS as recurrent primary disease, b) serious complications and c) psychological problems were present in 47% of all cases. FSGS was observed at a significantly higher rate in the dialysis group (43%) than in the transplant group (8%). In 48% of the dialysis group, renal transplants were only possible with cadaver kidneys, while 14% showed difficulties even with cadaver kidney. In conclusion, one of major potential solutions to improve the rate of renal transplantation in children in Japan is to enhance renal organ donation. The responsible pediatrician should serve a central role providing both essential information and support to decide whether to choose renal transplantation.
