Outcomes and Risk Factors for Graft Loss: Lessons Learned from 1,056 Pediatric Kidney Transplants at the University of Minnesota

• Published in: Journal of the American College of Surgeons Vol. 224; no. 4; pp. 473 - 486
• Main Authors: Chinnakotla, Srinath, MD, FACS, Verghese, Priya, MD, Chavers, Blanche, MD, Rheault, Michelle N., MD, Kirchner, Varvara, MD, Dunn, Ty, MD, FACS, Kashtan, Clifford, MD, Nevins, Thomas, MD, Mauer, Michael, MD, Pruett, Timothy, MD, FACS
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-04-2017
• Subjects: Adolescent; Child; Child, Preschool; Databases, Factual; Female; Follow-Up Studies; Graft Rejection - epidemiology; Graft Rejection - etiology; Graft Rejection - prevention & control; Graft Survival; Humans; Immunosuppressive Agents - therapeutic use; Infant; Infant, Newborn; Kaplan-Meier Estimate; Kidney Failure, Chronic - mortality; Kidney Failure, Chronic - surgery; Kidney Transplantation - mortality; Living Donors; Male; Risk Factors; Surgery; Survival Rate; Treatment Outcome; ESRD; DD; IgA; RPGN; cyclosporin A; Estimated glomerular filtration rate; Kidney; Outcomes; Transplant; end stage renal disease; GFR; deceased donor; GBM; chronic GN; rapidly progressive GN; FSGS; PTLD; panel-reactive antibody; post-transplant lymphoproliferative disorder; SrC; MMF; GN; immunoglobulin A; CGN; MALG; focal segmental glomerulosclerosis; MPGN; PUV; CsA; living donor; Immunosuppression; congenital posterior urethral valves; Serum Creatinine; LD; mycophenolate mofetil; glomerular basement membrane; glomerulonephritis; Pediatric; Minnesota anti lymphocyte globulin; PRA; membranoproliferative GN; SCr; HLA
• ISSN: 1072-7515; 1879-1190
• DOI: 10.1016/j.jamcollsurg.2016.12.027

Abstract Background Advances in immunosuppression, surgical techniques, and management of infections in children receiving kidney transplants have impacted outcomes. Study Design We analyzed a prospectively maintained database of pediatric kidney transplants. Results From June 1963 through October 2016, we performed 1,056 pediatric kidney transplants. Of these 129 were < 2 years old. The most common indications for transplant were congenital anomalies (dysplastic kidneys), obstructive uropathy and congenital nephrotic syndrome. Living donors constituted 721 (68%) of all donors. The graft and patient survival rates remarkably improved for both deceased and living donor recipients (p=0.001). Currently, the graft survival rates for deceased donor recipients are 92% at 1 year, 76% at 5 years, and 57% at 10 years post-transplant; for living donor recipients, 96% at 1 year, 85% at 5 years and 78% at 10 years. The graft half-life was 19 years in deceased donor recipients, compared with 25 years in living donor recipients (P ≤ 0.001). Acute rejection was the most common cause of graft loss in the first year post-transplant. The following risk factors were associated with an increased risk of graft loss: deceased donor grafts (p=0.0001), re-transplant (P=0.02), ages 11 to 18 years (P=0.001) and pre-transplant urologic issues (P=0.04). Living donor grafts (p=<0.0001) and preemptive transplants (p=0.02) were associated with decreased risks of graft loss. Conclusions The success rates of pediatric kidney transplants have significantly improved. Preemptive kidney transplant with a living donor graft continues to be superior and should be the choice in children with end stage renal disease.