Outcome differences between young children and adolescents undergoing kidney transplantation

Abstract Background/Purpose Although graft loss remains the biggest challenge for all pediatric kidney transplant (KT) recipients, unique challenges exist within different age groups. We aim to evaluate the different characteristics and graft survival outcomes of young children and adolescents under...

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Bibliographic Details
Published in:	Journal of pediatric surgery 2015-06, Vol.50 (6), p.996-999
Main Authors:	Bobanga, Iuliana D, Vogt, Beth A, Woodside, Kenneth J, Cote, Devan R, Dell, Katherine M, Cunningham, Robert J, Noon, Kelly A, Barksdale, Edward M, Humphreville, Vanessa R, Sanchez, Edmund Q, Schulak, James A
Format:	Article
Language:	eng
Subjects:	Adolescence Adolescent Age Factors Child Child, Preschool Female Graft Rejection - epidemiology Graft Rejection - etiology Graft Survival Humans Infant Infant, Newborn Kaplan-Meier Estimate Kidney transplantation Kidney Transplantation - mortality Male Multivariate Analysis Outcome Assessment (Health Care) Pediatric Pediatrics Proportional Hazards Models Rejection Retrospective Studies Sex Factors Surgery
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Summary:	Abstract Background/Purpose Although graft loss remains the biggest challenge for all pediatric kidney transplant (KT) recipients, unique challenges exist within different age groups. We aim to evaluate the different characteristics and graft survival outcomes of young children and adolescents undergoing KT. Methods Children who underwent isolated KT between 2000 and 2013 at our institution were included in this retrospective analysis. Patient characteristics and outcomes were compared using student’s t-test, chi-square test, Kaplan-Meier curve and Cox proportional hazards model. Results Of 73 children who underwent KT, 31 were < 12 (young children), and 42 were ≥ 12 years old (adolescents). Overall patient survival was 100%. The younger group had superior 5-year (100% vs. 75.5%) and 10-year (94.4% vs. 43.8%) graft survival (p = 0.008). Factors predictive of poor graft survival on multivariate analysis were older age at transplantation (HR 1.2, CI 1–1.4, p = 0.047), female gender (HR 9.0, CI 1.9–43, p = 0.006), and acute rejection episodes (HR 13, CI 2–90, p = 0.008). The most common causes of graft loss were acute and chronic rejection episodes and immunosuppression nonadherence. Conclusion Adolescents undergoing KT have inferior graft survival compared to younger children. In adjusted modeling, children with older age, female gender, and acute rejection episodes have inferior graft survival.
ISSN:	0022-3468 1531-5037