It was not until 1984 that pediatric transplantation mushroomed at the University of Utah. I think this was due to the use of cyclosporin as well as a critical mass of physicians at the University who were interested in pediatric transplantation. Living related kidneys do in general work better and last longer. We presume that living related kidneys do better because the surgery is planned and the recipient can be in the best possible medical shape, the kidney is as normal as we can assure ourselves through pre-donation testing and there is no cold storage. Additionally though, the genes of the donor are closer to the genes of the recipient in the living related transplant and that means that the body will be less likely to reject the kidney.
Recipient factors are also important and influence graft survival.
These factors include the age of recipient, the drugs used for immunosuppression, the number of transplants received plus many others. Recent studies have shown that if kidneys from donors under 5 years of age are used, it is best to put them into small recipients for example, those under 10 years of age. Small kidneys put into adults and small kidneys put into those under 1 year of age do not do as well as bigger kidneys. We think this is related to difficulty diagnosing rejection and technical difficulties for the surgeon during implantation. This fact is recognized in the national donation policies which mandate that donor kidneys under the age of 15 be implanted into children under the age of 10.