소아 신이식의 임상적 고찰

Abstract

We studied retrospectively 17 patients(<19 years old), who received living-donor renal transplantation between Nov. 1982 and May. 1994. Recipients were composed of 10 males and 7 females, with mean age of 16.5 years old(range: 7-19). The causes of renal failure were chronic glomerulonephritis in 6 patients(2 focal segmental glomerulosclerosis, 2 IgA nephropathy, 1 membranoproliferative glomerulonephritis, 1 nephrotic syndrome), urinary tract anomalies in 2 patients(vesicoureteral reflux and anterior urethral valve in each) and unknown cause in 9 patients. The incidence of urologic anomalies in children was more frequent than adult. Immunosuppression after transplantation was with cyclosporine-A and prednisolone in all patients. Acute rejection occurred in 4 patients, who were recovered after steroid pulse therapy. One patient lost the graft because of chronic rejection. Postoperative complications were 2 perirenal hematoma, 2 bacterial urinary tract infection, 2 avascular necrosis of hip joint, 1 cytomegalovirus(CMV`) pneumonia, 1 miliary tuberculosis, and 1 hirsuitism. There were 2 deaths, and the causes of death were CMV pneumonia and pulmonary edema. The results of renal transplantation in children were not satisfactory in comparison to those achieved in adults. Although successful renal transplantation in children with end stage renal disease appears to permit the maximal opportunity for growth and development, some problems such as dosage of immunosuppressants, fluid and electrolyte balance, nutritional support remain a persistent obstacle to long term survival. So more research to these problems will be necessary to improve of graft salvage and survival in children. Key word : Children, Renal transplantation.