Pediatric renal transplantation from the early 1970's through the cyclosporine years at Policlinico University Hospital of Milan.

In our 27 years' experience, 268 kidney transplantations have been carried out in 243 patients, who were under age 18 at the time of operation. Most (84.7%) received a cadaver donor graft. Immunosuppressive treatment with Cyclosporine (CsA) of the most recent 190 recipients resulted in a one-year graft survival rate gain from 51.0-86.5% compared with conventional azathioprine and prednisone therapy previously administered. The impact of the donor age was perhaps the main factor determining the outcome of pediatric transplantation, with a one-year graft survival rate ranging from 71.0-94.2% for grafts from donors aged 2-24 months or 11-18 years, respectively. Exvivo reconstruction and variations of the standard technique assure better success in the case of small kidneys (9 cases) or grafts with multiple/damaged arteries (58 cases).