Changing trends in pediatric transplantation: 2001 Annual Report of the North American Pediatric Renal Transplant Cooperative Study

Abstract

The North American Pediatric Renal Transplant Cooperative Study has collected clinical information on children undergoing a renal transplantation since 1987. This cooperative group now includes over 150 participating medical centers in the United States, Canada, Mexico, and Costa Rica. This report covers the years from 1987 through 2001 and includes data on 7545 renal transplants in 6878 patients. This report demonstrates changing trends in many areas of pediatric transplantation including increasing numbers of African American and Hispanic children receiving transplantation, remarkable improvements in the rate of acute rejection, rejection reversal, and short- and long-term allograft survival. In the most recent cohorts of patients, we now see that 1-yr allograft survival is no different in cadaver donor compared to living donor recipients and in infants compared to all other age groups. However, this analysis also reveals areas of continued challenges including inferior outcomes in African American and adolescent populations, chronic rejection, and the adverse effects of immunosuppression.

Safety and Efficacy of a Calcineurin Inhibitor Avoidance Regimen in Pediatric Renal Transplantation

“…Sustained proteinuria beyond 1 mo was identified in four patients, one of whom had donor pathology identified at the implantation biopsy, and two others had early acute rejection episodes. The 45% rate of treated hypertension at 1 yr was substantially lower than the 70% rate generally reported in pediatric renal transplant recipients (5).…”

“…Much of the improvement in organ transplantation outcomes has been due to the prevention of early acute rejection episodes and prompt identification and treatment when they occur (5,(7)(8)(9). Whereas some single-center reports have described rates of acute rejection episodes as low as 13 to 26% at 1 yr in selected groups of pediatric recipients (10 -13), large multicenter studies have reported rates as high as 27 to 59% (14 -19).…”

“…For years, however, children had poor outcomes and were considered to be high risk as compared with adults (4). Improvements in donor selection, surgical techniques, and knowledge of immunosuppressive drug doses and metabolism in children have led to substantial improvements in pediatric kidney graft and patient survival (5,6). The improvement in outcomes in children have exceeded those of adults, and children who are younger than 10 yr now have the best outcomes of all age groups of kidney transplant recipients (6).…”

“…Registry studies have reported that overall 6-mo acute rejections rates of 45% in deceased-donor and 32% in living-donor kidney transplants in 1992 fell to 21 and 20%, respectively, by 2003 (20). The North American Pediatric Renal Transplant Cooperative Study (NAPRTCS) reported a 57% first-year acute rejection rate in pediatric renal transplant recipients in 1987 that decreased to 32% by 2001 (5).…”

Congenital Nephrotic Syndrome

“…Overall, the results of kidney transplantation in CNS are quite good and similar to those obtained in other etiologies. Patient survival at 5 years is over 90% and graft survival over 80% in registry databases and in single centers [40,41]. Chronic allograft nephropathy, however, is a major problem also in these patients, and a second transplantation is inevitable when the patients become young adults.…”