Determinants of graft survival in pediatric and adolescent live donor kidney transplant recipients: A single center experience

Abstract

To study the independent determinants of graft survival among pediatric and adolescent live donor kidney transplant recipients. Between March 1976 and March 2004, 1600 live donor kidney transplants were carried out in our center. Of them 284 were 20 yr old or younger (mean age 13.1 yr, ranging from 5 to 20 yr). Evaluation of the possible variables that may affect graft survival were carried out using univariate and multivariate analyses. Studied factors included age, gender, relation between donor and recipient, original kidney disease, ABO blood group, pretransplant blood transfusion, human leukocyte antigen (HLA) matching, pretransplant dialysis, height standard deviation score (SDS), pretransplant hypertension, cold ischemia time, number of renal arteries, ureteral anastomosis, time to diuresis, time of transplantation, occurrence of acute tubular necrosis (ATN), primary and secondary immunosuppression, total dose of steroids in the first 3 months, development of acute rejection and post-transplant hypertension. Using univariate analysis, the significant predictors for graft survival were HLA matching, type of primary urinary recontinuity, time to diuresis, ATN, acute rejection and post-transplant hypertension. The multivariate analysis restricted the significance to acute rejection and post-transplant hypertension. The independent determinants of graft survival in live-donor pediatric and adolescent renal transplant recipients are acute rejection and post-transplant hypertension.

An update and review of acute kidney injury in pediatrics

“…Aberrations in the intricate regulatory mechanism in place to maintain renal perfusion pressure (Table 3) lead to injury such as acute tubular necrosis (13). Pediatric kidney transplant recipients of organs with increased ischemic times during harvest have increased rates of acute tubular necrosis (14), as do patients with long crossclamp times during cardiopulmonary bypass (CPB) (15,16). Direct effects on renal blood flow in the microvasculature of the vasa recta occur in sickle cell disease, rhabdomyolysis, hemolytic uremic syndrome, and tumor lysis syndrome.…”

Longitudinal relations between obesity and hypertension following pediatric renal transplantation

“…Subsequent studies using ambulatory blood pressure monitoring have underscored the burden of this complication, demonstrating that hypertension is frequently under-recognized and inadequately controlled in these children and adolescents [17][18][19][20]. Furthermore, hypertension following renal transplantation is an important independent predictor of short-term allograft dysfunction and long-term graft failure [21][22][23][24][25].…”

Oral Session: Kidney III: Sensitization and Antibody‐Mediated Rejection

“…The association between AR and graft outcomes in adult kidney transplant recipients is well established [1] . In paediatrics this association has been demonstrated in small single-center studies [2] [3] . A recent large paediatric registry study demonstrated AR in the 1st year post-transplant as a major risk factor for graft loss (adjusted HR 2.11 (1.81-2.47)p <.001), but not mortality [4] .…”