Pediatric kidney transplantation has a great benefit for quality of life and growth of the children with end-stage renal disease. Peritoneal dialysis for children has improved remarkably but does not always promise better life for them. However we have to overcome several problems to achieve the good outcome of pediatric kidney transplantation. Regarding of size mismatch between an adult kidney and a small body, the cardiovascular management in anesthesia as well as surgical technique is not easy. With the strict monitoring by Swan-Ganz catheter and trans-esophageal ultrasound, fluid was infused properly and the dose of dopamine was adjusted in the small children with low body weight. Post-transplant Infection seems to be critical because many children are sero-negative for CMV and EBV.
We had 70 first living related kidney transplantations in children (<18 years old) from April 1978 to April 2004. Overall 5 and 10 years graft survival rates were 96% and 85% respectively. None of 41 children have lost a graft since 1997 (follow-up: 6-93 months). Out of 10 children less than 10kg body weight (6.6-10kg: mean 8.6 kg), 9 have been alive with good graft function for 6-196 months post-transplantation. ABO incompatible kidney transplantation was performed in 12 children (6-18 years old). All children are alive and all grafts are functioning (follow-up 21-132 months: mean 63 months). Recent immunosuppressive protocol including basiliximab and MMF provided excellent outcome and growth. Five children withdrew steroid and 3 have steroid alternative day among 12 children. Seven children obtained catch-up growth under this regimen. All 12 children are alive and all grafts are functioning as well (follow-up 6-31months: mean 9months).