Between January 1, 1978, and August 31, 1985, 13 infants aged 6 to 11 months received primary renal transplants (12, living related donor; one cadaver) at the University of Minnesota. Twelve infants are alive with functioning graffs (10 primary and two second transplants) after 4 months to 7.5 years. To assess the long-term outcome, we analyzed growth and development in the first nine infants 2 to 7.5 years after receiving their first transplant. Before transplantation, head circumference and height standard deviation scores in six of nine infants were <-2. Five had seizures; four had delayed mental development, and six delayed motor development. The mean increment in height standard deviation scores for six boys after transplantation was +1.4 (P <0.05), and one achieved complete catch-up growth. The mean difference in height standard deviation scores for three infant girls with primary hyperoxaluria was -2.1; nevertheless, two infants with oxalosis are currently alive 2.7 to 3.3 years later. All eight surviving children achieved normal head circumference (mean improvement +2.2 SDS, P <0.001), and no child had further seizures. Of seven infants reassessed with the Bayley Scales after transplantation, mental development was normal in all and motor development was normal in five. Our findings suggest that early living related renal transplantation is an important option in the management of end-stage renal disease in infants.
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Infants with end-stage renal disease present both management and moral dilemmas. They often have extremely stunted growth v6 and are at risk for a syndrome of progressive encephalopathy that may not be reversed by transplantation or hemodialysis ifi later childhood?, 6 However, the value of early renal replacement therapy in the management of ESRD is not established/Previously, renal transplantation in infants carried a formidable morbidity and mortality. 7-~~ In addition, maintenance dialysis w,a s Presented in part at the 10th International Congress of the Transplantation Society, Minneapolis, August 26-31, 1984. Supported by Grants 1R01-HD 17386-01 and AM 13083 from the National Institutes of Health. Submitted for publication June 30, 1986; accepted Sept. 22, 1986.