2002, Number 2
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ABSTRACTObjective: To demonstrate the degree of functionality of pediatric grafts from cadaveric donors of different ages.
Setting: Third level health care hospital.
Design: Retrospective case studies.
Material and methods: From January 1st, 1995 to August 31st, 1997 (32 months) 38 multiple organ procurements were effectively accomplished. Thirty renal grafts were obtained from pediatric donors. Perfusion with MPS solution and simple hypothermia preservation was used for all procedures made in donors of less than 15 years of age. Donors were divided in two subgroups: Group A (1-4 years of age) and B (5 to 14 years of age). The receptors received a triple immunosuppressor scheme, cyclosporine-A (CyA), azathioprine (Aza) and prednisone (Pdn). Steroid-resistant cases were treated with monoclonal antibodies (OKT-3) according to the conventional scheme.
Results: From the 38 procurements, 10 corresponded to children under 15 years of age. From the 20 available grafts, 18 were transplanted, since one renal block presented generalized hemorrhagic spots. Subgroup A comprised 14 grafts, of which four presented dysfunction and two more had macroscopic alterations (43%). Subgroup B, with six grafts from three donors, presented a 100% functionality at 1 year and only one presented two acute rejection episodes that responded favorably to treatment. Three nephrectomies of the graft were performed in subgroup A, caused by venous thrombosis, severe cardiac failure in one marginal patient with functioning graft, and rupture of the graft due to non-vascular cause in another.
Conclusion: Grafts from pediatric donors under six years of age presented 43% of primary dysfunction. Donors over 5 years of age presented a satisfactory evolution and favorable prognosis.
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