Challenges in pediatric renal transplantation in developing countries.

PURPOSE OF STUDY: The present review summarizes the findings of most important reports on pediatric transplants from the developing world and highlights the challenges and results of the activity.

RECENT FINDINGS: In the past 3 years, 10 reports appeared in the literature on pediatric renal transplantation and further six more in the past 5 years. The experience ranges from 1 to 28 years for 11-300 transplants. Recipients were older than 6 years and donors were living relatives in more than 94% of the series. Cyclosporine, azathioprin and steroids are the mainstay of immunosuppression and in many centres the high costs of drugs resulted in noncompliance and discontinuation of immunosuppression. Therefore, acute rejection rates were high, more than 40% in half of the series. One-year and 5-year survival rates for grafts were 89-98% and 67-84% and for patients 88-98% and 65-90%, respectively. Major causes of graft loss were chronic rejection, acute rejection and infection and for the patients, it was infection. Growth analysis is not generally reported but when reported the deficit remains or gets worse.

SUMMARY: Pediatric transplantation activity in the developing world is limited to older children using mostly living related parental donors. High rejection and infection rates result in poor patient and graft survival.