• To determine one-year graft function, as measured by graft survival and serum creatinine of children undregoing OKT3 induction versus no induction [ Time Frame: At 1 year ] [ Designated as safety issue: No ]
• To compare the efficacy of Sandimmune and Neoral with respect to graft function [ Time Frame: Throughout study ] [ Designated as safety issue: No ]

• To determine one-year graft function, as measured by graft survival and serum creatinine of children undregoing OKT3 induction versus no induction
• to compare the efficacy of Sandimmune and Neoral with respect to graft function

• Two and four-year graft functions [ Time Frame: At 2 and 4 years ] [ Designated as safety issue: No ]
• Safety with respect to viral infections and malignancies in children undergoing a renal transplant [ Time Frame: Throughout study ] [ Designated as safety issue: Yes ]
• Frequency and severity of rejection episodes [ Time Frame: Throughout study ] [ Designated as safety issue: Yes ]
• Time to first rejection [ Time Frame: Throughout study ] [ Designated as safety issue: No ]
• Length and frequency of hospitalization [ Time Frame: Throughout study ] [ Designated as safety issue: No ]
• Nature of acute cellular rejection at a molecular level [ Time Frame: Throughout study ] [ Designated as safety issue: No ]
• Nature of "heightened immune respons" of younger children by studying gene expression in surveillance biopsies [ Time Frame: Throughout study ] [ Designated as safety issue: No ]
• Correlate intragraft events during rejection with cytokine profile in the peripheral blood [ Time Frame: Throughout study ] [ Designated as safety issue: No ]

• two and four -year graft functions
• safety with respect to viral infections and malignancies in children undergoing a renal transplant
• frequency and severity of rejection episodes
• time to first rejection
• length and frequency of hospitalization
• nature of acute cellular rejection at a molecular level
• nature of "heightened immune respons" of younger children by studying gene expression in surveillance biopsies
• correlate intragraft events during rejection with cytokine profile in the peripheral blood

Kidney transplantation is often successful. However, despite aggressive anti-rejection drug therapy, some patients will reject their new kidney. This study is designed to test two anti-rejection approaches. Two medications in this study are currently used in children, but there is no information regarding which drug is safer or more effective.

Survival rates in renal transplantation are unacceptably low. Therefore, there is a need for an improved post-transplant treatment, such as the induction therapy used in this study.

Renal transplantation is recognized as the treatment of choice for children with chronic renal failure. However, patient and graft survival rates in young children are unacceptably low. In preliminary studies, OKT3 (a monoclonal antibody) induction therapy received post transplant has been more successful than standard immunosuppression alone in improving graft survival. This study is designed to assess the impact of induction therapy on graft survival in pediatric kidney transplant patients.

Patients are assigned to OKT3 induction or no induction in a 1:1 ratio. Randomization to oral cyclosporine of either Sandimmune or Neoral is also done in a 1:1 ratio. Group 1 receives OKT3 intraoperatively followed by Neoral. Group 2 receives OKT3 intraoperatively followed by Sandimmune. OKT3 is administered at 2.5 mg (if weight less than 30 kg) or 5 mg (if weight above 30 kg) per day for a maximum of 14 days. Group 3 receives IV cyclosporine followed by Neoral. Group 4 receives IV cyclosporine followed by Sandimmune. Oral cyclosporine is administered in a masked preparation. The dose for Sandimmune and Neoral is the same; patients 6 years of age and older begin at a dose of 15 mg/kg/day and patients under 6 years of age receive 500 mg/m2/day. Patients will receive concomitant medications including steroids (IV and po), Nifedipine, anti-CMV therapy, Bactrim, Azathioprine or Mycophenolate Mofetil. Kidney function, incidence of viral infection, graft survival, and incidence of malignancy will be measured to assess the role of OKT3 induction and the role of rejection in graft failure. Graft function will be evaluated at 1-, 2-, and 4-year intervals.

• Drug: OKT3
• Drug: Oral Cyclosporine
• Drug: IV Cyclosporine

• Experimental: Patients receiving induction therapy
• Experimental: Patients not receiving induction therapy

Inclusion Criteria

Children and young adults may be eligible for this study if they:

• Are not yet 21 years of age.
• Are receiving their first or second transplant.
• Are not pregnant.
• Agree to practice sexual abstinence or agree to use an effective
• method of birth control/contraception during the study and
• for 1 year after.

Exclusion Criteria

Children and young adults will not be eligible for this study if they:

• Are recipients of multiple organs other than kidneys.
• Are recipients of three or more transplants.
• Are HIV positive.
• Are Hepatitis B surface antigen positive.