Risk Factor Analysis for Long-Term Graft Survival Following Pediatric Kidney Transplantation: The Importance of Pretransplantation Time on Dialysis and Donor/Recipient Age Difference

Recognizing risk factors that may negatively affect long-term graft survival following pediatric kidney transplantation is a key element in the decision-making process during organ allocation. We retrospectively reassessed all cases of pediatric kidney transplantation performed in our center in the last 20 years with the aim of determining baseline characteristics that could be identified as prognostic risk factors for long-term graft survival. Between 2001 and 2020, a total of 91 kidney transplantations in children under the age of 18 years were undertaken in our center. Early graft failure was observed in six of the 91 patients (7%). The median follow-up of the remaining 85 children was 100 months, and the overall kidney graft survival rates at 5, 10, 15 and 20 years were 85.2%, 71.4%, 46.0% and 30.6%, respectively. Small children with a body surface area of <1 m2 were significantly associated with better long-term graft survival outcomes, while adolescents aged more than twelve years showed poorer graft survival rates than younger children. Body surface area of the recipient of ≥1 m2, pretransplantation duration of the recipient on dialysis ≥18 months, hemodialysis prior to transplantation and donor/recipient age difference of ≥25 years were significantly associated with poorer long-term graft survival.

[1]  B. Hutton,et al.  Association Between Pretransplant Dialysis Modality and Kidney Transplant Outcomes , 2022, JAMA network open.

[2]  W. Feitz,et al.  Pearls and Pitfalls in Pediatric Kidney Transplantation After 5 Decades , 2022, Frontiers in Pediatrics.

[3]  Rachel J. Johnson,et al.  Transplant and Recipient Factors in Prediction of Kidney Transplant Outcomes: A UK-Wide Paired Analysis , 2022, Journal of clinical medicine.

[4]  S. Hariharan,et al.  Impact of Size Matching Based on Donor-Recipient Height on Kidney Transplant Outcomes , 2022, Transplant International.

[5]  V. Papalois,et al.  The Impact of Cold Ischaemia Time on Outcomes of Living Donor Kidney Transplantation: A Systematic Review and Meta-Analysis , 2022, Journal of clinical medicine.

[6]  S. Parajuli,et al.  The Role of Peritoneal Dialysis in Different Phases of Kidney Transplantation , 2022, Kidney360.

[7]  G. Kundt,et al.  Predictors of Delayed Graft Function in Renal Transplantation , 2021, Urologia Internationalis.

[8]  S. Marks,et al.  The impact of donor and recipient sex on kidney allograft survival in pediatric transplant recipients , 2021, Pediatric Nephrology.

[9]  W. Feitz,et al.  Prognostic Factors on Graft Function in Pediatric Kidney Recipients. , 2020, Transplantation proceedings.

[10]  C. McCulloch,et al.  Trends in Cardiovascular Mortality Among a Cohort of Children and Young Adults Starting Dialysis in 1995 to 2015 , 2020, JAMA network open.

[11]  H. Cardinal,et al.  Donor Age, Donor-Recipient Size Mismatch, and Kidney Graft Survival. , 2020, Clinical journal of the American Society of Nephrology : CJASN.

[12]  Rachel Hogen,et al.  Pediatric kidney transplantation in the United States. , 2020, Current opinion in organ transplantation.

[13]  D. Zwolińska,et al.  Kidney transplantation and other methods of renal replacement therapy in children: 30 years of observations in one center. , 2020, Advances in clinical and experimental medicine : official organ Wroclaw Medical University.

[14]  J. J. Homan van der Heide,et al.  Impact of Cold Ischemia Time on Outcomes of Deceased Donor Kidney Transplantation: An Analysis of a National Registry , 2019, Transplantation direct.

[15]  Douglas E Schaubel,et al.  US Renal Data System 2018 Annual Data Report: Epidemiology of Kidney Disease in the United States. , 2019, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[16]  D. Hébert,et al.  Clinical implication of renal allograft volume to recipient body surface area ratio in pediatric renal transplant , 2018, Pediatric transplantation.

[17]  H. Cheong,et al.  Impact of end‐stage renal disease in children on their parents , 2018, Nephrology.

[18]  S. McTaggart,et al.  The impact of donor/recipient age difference and HLA mismatch on graft outcome in pediatric kidney transplantation , 2018, Pediatric transplantation.

[19]  F. Friedersdorff,et al.  Long-Term Follow-Up after Paediatric Kidney Transplantation and Influence Factors on Graft Survival: A Single-Centre Experience of 16 years , 2018, Urologia Internationalis.

[20]  B. Warady,et al.  Care of the Pediatric Patient on Chronic Dialysis. , 2017, Advances in chronic kidney disease.

[21]  B. Tönshoff,et al.  The association of donor and recipient age with graft survival in paediatric renal transplant recipients in a European Society for Paediatric Nephrology/European Renal Association–European Dialysis and Transplantation Association Registry study , 2017, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[22]  B. Astor,et al.  Association of Pre-Transplant Dialysis Modality and Post-Transplant Outcomes: A Meta-Analysis , 2017, Peritoneal Dialysis International.

[23]  B. Chavers,et al.  Outcomes and Risk Factors for Graft Loss: Lessons Learned from 1,056 Pediatric Kidney Transplants at the University of Minnesota. , 2017, Journal of the American College of Surgeons.

[24]  N. Kutner,et al.  Preemptive kidney transplantation is associated with survival benefits among pediatric patients with end-stage renal disease. , 2016, Kidney international.

[25]  F. Schaefer,et al.  Mortality risk in European children with end-stage renal disease on dialysis. , 2016, Kidney international.

[26]  A. Rule,et al.  Aging and the Kidneys: Anatomy, Physiology and Consequences for Defining Chronic Kidney Disease , 2016, Nephron.

[27]  D. Segev,et al.  National Trends Over 25 Years in Pediatric Kidney Transplant Outcomes , 2014, Pediatrics.

[28]  I. Narita,et al.  Effect of donor–recipient age difference on long-term graft survival in living kidney transplantation , 2014, International Urology and Nephrology.

[29]  K. V. van Stralen,et al.  Epidemiology of chronic kidney disease in children , 2011, Pediatric Nephrology.

[30]  S. McDonald,et al.  Effect of donor-recipient age difference on graft function and survival in live-donor kidney transplantation. , 2011, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[31]  F. Collart,et al.  Clinical characteristics and outcomes of children with stage 3–5 chronic kidney disease , 2010, Pediatric Nephrology.

[32]  Jodi M. Smith,et al.  The relationship of donor source and age on short‐ and long‐term allograft survival in pediatric renal transplantation , 2009, Pediatric transplantation.

[33]  Arthur V. Iansavichus,et al.  Recipient Outcomes for Expanded Criteria Living Kidney Donors: The Disconnect Between Current Evidence and Practice , 2009, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[34]  F. Dobbels,et al.  Adherence to the immunosuppressive regimen in pediatric kidney transplant recipients: A systematic review , 2009, Pediatric transplantation.

[35]  A. Cabrita,et al.  The influence of HLA mismatches and immunosuppression on kidney graft survival: an analysis of more than 1300 patients. , 2007, Transplantation proceedings.

[36]  J. Nauta,et al.  Kidney Transplantation Without Prior Dialysis in Children: The Eurotransplant Experience , 2006, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[37]  D. Hsu Biological and psychological differences in the child and adolescent transplant recipient , 2005, Pediatric transplantation.

[38]  J. Groothoff Long-term outcomes of children with end-stage renal disease , 2005, Pediatric Nephrology.

[39]  J. Craig,et al.  Long-term survival of children with end-stage renal disease. , 2004, The New England journal of medicine.

[40]  Jae-Hyun Chang,et al.  Donor-recipient age difference and graft survival in living donor kidney transplantation. , 2012, Transplantation proceedings.

[41]  G. Russell,et al.  Dialysis modality and delayed graft function after cadaveric renal transplantation. , 1999, Journal of the American Society of Nephrology : JASN.