Factors influencing short-term and long-term pediatric renal transplant survival

Schurman, Scott J.; McEnery, Paul T.

doi:10.1016/s0022-3476(97)70210-5

Cited by 55 publications

(49 citation statements)

References 22 publications

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“…Salvatierra et al also reported that a lower incidence of acute rejection was associated with higher 3-year graft survival rates but did not evaluate for half-lives (7). Two recent studies on long-term graft survival in pediatric renal Tx patients also did not evaluate acute rejection as an independent risk factor for graft survival (4,6). Donor source has also been shown to have an important ef-fect on graft survival (1,4,(6)(7)(8)14).…”

Section: Renal Graft Survival and Half-lives In Childrenmentioning

confidence: 99%

“…Two recent studies on long-term graft survival in pediatric renal Tx patients also did not evaluate acute rejection as an independent risk factor for graft survival (4,6). Donor source has also been shown to have an important ef-fect on graft survival (1,4,(6)(7)(8)14). Our data show that the T1/ 2 of LD grafts (14.7 years) is significantly better than the T1/ 2 of CAD grafts (9.3 years), and these results are similar to those reported by others (4,6).…”

Section: Renal Graft Survival and Half-lives In Childrenmentioning

confidence: 99%

See 1 more Smart Citation

Improved Late Graft Survival and Half-Lives in Pediatric Kidney Transplantation: A Single Center Experience

Vats

Gillingham

Matas

et al. 2002

American Journal of Transplantation

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We evaluated variables associated with improved late graft survival in 290 children transplanted between 11/ 1/1984 and 12/31/1997, and who had Ͼ1 year graft survival. We studied the following variables: age, gender, race, primary disease (diseases prone to recurrence, i.e. hemolytic uremic syndrome, focal segmental glomerulosclerosis or oxalosis vs. others), primary vs. retransplant; donor source, acute tubular necrosis, acute rejection episodes in the first year, transplant era and discharge serum creatinine. Graft half-life was defined as the time taken for 1/2 of the grafts functioning at 1 year to fail. There were 205 living donor and 85 cadaveric transplant. The cumulative graft survival at 5 and 10 years was 88% and 75% for living donor, and 72% and 46% for cadaveric, respectively. Multivariate analyses showed a higher late graft survival to be associated with: no acute rejection episodes (risk ratio 0.16, p Ω0.0001), age 2-5 years (risk ratio 0.24, p Ω 0.0007), living donor (risk ratio 0.46, p Ω0.017), primary nonrecurrent disease (risk ratio 0.29, p Ω0.001), Caucasian race (risk ratio 0.40, p Ω0.006). A high halflife was seen with living donor transplant (21.3 years) and the age group 2-5 years (27.5 years). Further, living donor patients with no acute rejection episodes had the best half-life of 37.6 years, while children with hemolytic uremic syndrome, focal segmental glomerulosclerosis or oxalosis had the lowest overall half-life of 5.6 years. This study finds that living donor, no acute rejection episodes, age 2-5 years, Caucasian race and having a disease not prone to recurrence are strong predictors of late graft survival. Hence, preferential use of living donor and prevention of acute rejection episodes in the first year are key variables that can improve long-term renal graft survival in children.

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Section: Renal Graft Survival and Half-lives In Childrenmentioning

confidence: 99%

Section: Renal Graft Survival and Half-lives In Childrenmentioning

confidence: 99%

Improved Late Graft Survival and Half-Lives in Pediatric Kidney Transplantation: A Single Center Experience

Vats

Gillingham

Matas

et al. 2002

American Journal of Transplantation

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“…prine and steroids, long term allograft survival may not be improved [27]. The incidence of acute rejection epiIntroduction Although the introduction of Cyclosporine (CyA) has vastly improved 1-year allograft survival in children when compared to immunosuppression with Azathiosodes, possibly in association with unsatisfactorily low CyA concentrations in the first year, have been associated with poor long term outcome [ l l , 321.…”

mentioning

confidence: 99%

Effect of adding Mycophenolate mofetil in paediatric renal transplant recipients with chronical cyclosporine nephrotoxicity

et al. 2000

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Cyclosporine (CyA) has made a great impact on 1-year allograft survival, however, after years, renal function deteriorates, possibly due to chronic toxicity. Recently, Mycophenolate mofetil (MMF) was introduced as a nonnephrotoxic immunosuppressant that might be effective in chronical transplant arteriolopathy. We therefore started MMF at a dose of 600 mg/m2 b. i. d. in 18 pediatric renal transplant recipients (10.8 f 3.9 (SD) years of age at transplantation, 11/18 with a history of rejections) with biopsy-proven chronic arteriolopathy and other signs of CyA toxicity at a mean follow up time of 6.2 k 2.7 (range 2.3-11.8) years after transplantation. One month prior to conversion, mean serum creatinine was 171 the time of conversion (188 f 100 pmol/l, P = 0.003, paired t-test). At last follow-up (median 13.7 months, range 5.0 to 25.0 months) after conversion, mean serum creatinine decreased significantly to 127 t 69 pmolil ( P = 0,0003, paired t-test). The CyA dosage was reduced from a mean of 150 * 39 mg/ m2 per day to 59 f 13 mg/m2 per day 96 pmol/l, lower than at in 7 patients, and CyA was discontinued in 11 patients after a median period of nine months (range 1-18 months). After a median period of 21 days, a pharrnacokinetic profile was performed in all patients. The mean MMF dose was 1117 f 319 mg/m2 per day (range 675-1774 mg/m2 per day). The mean Mycophenolic acid (MPA) trough concentration was 4.0 k 2.0 pg/ml, range 1.4-7.9 pg/ml. Mean 12 h MPA AUC was 70.6 k 28.1 (range 31.9-127) pg x h/ml. Except for one patient with diarrhea associated with a high AUC, and for one patient with a steroid-sensitive rejection episode after 566 days, no other patient experienced side effects or a rejection episode. Prednisolone was left unaltered at 2-4 mg/m2 per day. We conclude that MMF allows safe reduction of CyA with markedly better graft function, suggesting that chronical CyA-toxicity partially accounts for deteriorating allograft function.

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“…2 Several papers, mainly from the United States, have reported that adults and African American child recipients had worse patient and transplant survival rates than did white recipients. [3][4][5][6][7][8] Biological factors such as different major histocompatibility complex antigens, and/or socioeconomic factors (eg, the lack of education), may have determined the unfavorable results in these studies. [9][10][11] A novel approach has been recommended to ensure well-matched transplants for younger patients, and human leukocyte antigen (HLA) matching is less important for older patients because revision transplant is less likely to be required.…”

Section: Introductionmentioning

confidence: 99%

Untitled

2015

Exp Clin Transplant

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Objectives: Kidney transplant is well accepted as the optimal therapy for children with end-stage renal disease, and new trends suggest using human leukocyte antigen-DR mismatched grafts. The aim of work was to assess the effect of human leukocyte antigen-DR mismatch on the outcome of pediatric renal transplant recipients, regardless of the source of kidney graft. Materials and Methods: According to human leukocyte antigen-DR matching, 104 pediatric patients were categorized into 3 comparable groups. With optimized immunosuppression protocols, long-term graft and patient outcomes were assessed. Results:We found that posttransplant complications were comparable in the 3 groups, without significant increase in the risk of infections or malignancies, especially in the full human leukocyte antigen-DR-mismatched group. Moreover, we found no significant difference in the 3 groups regarding long-term graft or patient survival. Conclusions: With optimization of immunosuppression, human leukocyte antigen-DR-mismatched donors can be safely accepted for pediatric kidney transplant with comparable long-term patient and graft survival.

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Factors influencing short-term and long-term pediatric renal transplant survival

Cited by 55 publications

References 22 publications

Improved Late Graft Survival and Half-Lives in Pediatric Kidney Transplantation: A Single Center Experience

Improved Late Graft Survival and Half-Lives in Pediatric Kidney Transplantation: A Single Center Experience

Effect of adding Mycophenolate mofetil in paediatric renal transplant recipients with chronical cyclosporine nephrotoxicity

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