NEW YORK (Reuters Health) - Long-term survival of children with end-stage renal disease (ESRD) has improved markedly during the past four decades, particularly in those who undergo transplantation, according to a report in the June 24th issue of The New England Journal of Medicine.

"There has been improvement in survival with both dialysis and transplantation over the past 40 years, although transplantation offers substantial survival advantages over dialysis," Dr. Stephen P. McDonald, from the Queen Elizabeth Hospital in Adelaide, South Australia told Reuters Health. "Therefore, increasing rates of transplantation among children is probably the best way to increase overall survival among this group."

Dr. McDonald, and Dr. Jonathan C. Craig from the University of Sydney, examined the long-term survival of 1,634 children and adolescents who were aged less than 20 years when they started renal-replacement therapy -- either dialysis or transplantation.

Survival was 79% at 10 years and 66% at 20 years. Mortality rates among these children were 30 times higher than in children without ESRD. However, Dr. McDonald added that "long term survival of children with ESRD is now possible."

The researchers also note that "the older a child is when renal-replacement therapy is required, the better his or her chances for long-term survival." This was particularly apparent in children younger than 12 months of age. Their risk of death was four times higher than in children who are in their teens when renal-replacement therapy is initiated.

"Perhaps more important," the authors observe, "is the finding that dialysis is associated with a risk of death that is four times the risk associated with renal transplantation." Moreover, "the improvement in survival after renal transplantation is substantial and sustained."

In an accompanying editorial, Dr. Dawn S. Milliner of the Mayo Clinic, Rochester, Minnesota observes that renal transplantation "should be undertaken as soon as possible after advanced renal failure becomes evident."

In fact, she concludes that "some would argue that transplantation is the only acceptable form of long-term treatment for patients in this age group."

N Engl J Med 2004;350:2637-2639,2654-2662

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