Search

This 9-month study compared the intraocular pressure (IOP)-lowering efficacy and safety of once-daily travoprost ophthalmic solutions (0.0015 and 0.004) with twice-daily timolol 0.5.

Hemolytic uremic syndrome (HUS) is the cause of renal failure in 2–4 of children on dialysis. After renal transplantation, HUS can recur, but recurrence rate and risk factors are controversial.

Posttransplant lymphoproliferative disorder (PTLD) is an important complication of transplantation. The North American Pediatric Renal Transplant Cooperative Study (NAPRTCS) database has documented 56 cases of PTLD, the largest such series to date.

Of 2213 primary transplants reported to NAPRTCS between 1/1/87 and 10/31/92, 581 (26.3%) were performed without prior dialysis. The rate of pre‐emptive transplantation (PET) differed by donor source, 35.7% LD and 16.1% CD (p<0.001); gender, 29.6% male and 21.1% female (p<0.001); race, 30.1% white, 16.1% black, 19.5% hispanic, and 20.2% other (p<0.001); recipient age, 0‐1 yr 18.7%, 2‐5 yr 27.9%, 6‐12 yr 30.5%, and 13‐17 yr 22.8% (p<0.001). The graft survival rate was significantly better for both the LD (p<0.01) and CD (p=0.01) grafts in the pre‐emptive group; however, the differences were not significant after adjustment for other variables. The major reasons for pre‐emptive transplantation were the parents' desire to avoid dialysis and the recommendation of the nephrologist/surgeon. The data indicate that preemptive transplantation does not adversely impact on transplant outcome and that the desire to avoid dialysis is the primary motivating factor.

Of 2457 patients in the North American Pediatric Renal Transplant Cooperative Study registry who were followed for 5481 patient-years after the index transplantation, we observed 136 deaths, for an average annual rate of 24.8 deaths per 1000 patient-years. Death resulted primarily from infection (n=55, 40), cardiovascular causes (n=28, 21), hemorrhage (n=16, 12), and malignancies (n=9, 7). Cadaver-donor source was associated with greater mortality (6.7) than a living-donor source (4.0) (P<0.005). Recipients aged 0–1, 2–5, 6–12, and 13–17 years old had mortality rates of 17.5, 8.0, 3.6, and 4.5, respectively (P<.001). Mortality rates increased substantially when examined by recipient and cadaver donor ages (mortality rates of up to 45), the greater the concordance between young donor and recipient ages. Interestingly, acute tubular necrosis and graft failure less than 30 days after transplantation (GH30) were each associated with markedly elevated mortality rates. (The risk ratio for ATN was 3.1 [P<0.001] and for GF30 it was 6.4 [P<0.001].) Mortality after transplantation was also affected by the underlying renal disease, with high mortality rates observed for oxalosis (n=21, 33.3), congenital nephrotic syndrome (n=79, 15.2), pyelo/ interstitial nephritis (n=54, 11.1), and Drash syndrome (n=14, 21.4).