Objective: To study outcomes and risk-factors for graft-loss in > 1000 pediatric kidney transplants.

Methods: We studied outcomes by immunosuppression era: I) 1963-83 (ATG, Imuran and steroids); II) 1984-2001 (introduction of CNIs); and III) 2001-present (steroid avoidance).

Results: 1010 transplants (Age<1yr=53, 1-2yr=124, 3-5yr=182, 6-10yr=216, 11-18=435) were done. (810 I^st; 200 retx) (LD=69%, DD=31%; 3% LURDs pre-2001, 17% since [p<.01]). Congenital-anomalies were the commonest indication (Table 1) Ten-yr actuarial patient-survival (p <0.001), graft survival (p=0.0005), and death-censored graft-survival (p=.02) steadily improved by era (Table 1). Graft half-life (starting @ 1 yr posttx) is 33 years for LDs, 14 years for DDs. Graft-loss for all causes < 1 year posttx has ⇓ by era (Table 1); from 1-5 yrs, CR/IFTA remains predominant. For the entire cohort, by multivariate-analysis, LD(p<.0001) and Era III (vs I and II) (p<.0003) had better survival.↑ LD donor age did not affect graft survival.Risk-factors for loss varied by era (Table 2). Successful transplant was associated with improved QoL, and return-to-school and (subsequently) work.

Conclusions: Long term Outcomes of pediatric renal transplantation have continued to improve. LD grafts provide the most benefit and should be the first option.

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