Long‐term outcomes of pediatric kidney transplantation: A single‐center experience over the past 34 years in Japan

Abstract

Objectives To evaluate long‐term outcomes and risk factors for graft loss in pediatric kidney transplantation over a 30‐year period. Methods We retrospectively assessed 400 consecutive kidney transplants carried out in 377 children during 1975–2009. Patients were stratified according to the immunosuppressive regimen (era 1: methylprednisolone and azathioprine; era 2: calcineurin inhibitor‐based therapy, including methylprednisolone and azathioprine or mizoribine; era 3: basiliximab induction therapy, including calcineurin inhibitors, methylprednisolone and mycophenolate mofetil). Results The median age and bodyweight at transplantation were 9.7 years and 20.6 kg, respectively. In total, 364 (91.0%) children received a living related donor transplantation. The acute rejection rate within 1 year post‐transplant decreased significantly from 61.0% in era 1 to 14.5% in era 3 (P < 0.001). For transplant eras 1–3, 1‐year graft survival was 81%, 93% and 95%; 5‐year graft survival was 66%, 86% and 93%; and 10‐year graft survival was 47%, 79% and 89%, respectively. The overall 5‐, 10‐ and 20‐year patient survival rates were 96%, 93% and 88%, respectively. A Cox multivariate analysis identified cold ischemia time (hazard ratio 1.385, 95% confidence interval 1.251–1.603), acute rejection (hazard ratio 1.682, 95% confidence interval 1.547–3.842), re‐transplant (hazard ratio 2.680, 95% confidence interval 1.759–3.982) and donor type (hazard ratio 2.957, 95% confidence interval 1.754–4.691) as independent risk factors for graft loss at 10 years post‐transplant. Conclusions The progress of immunosuppressive therapy has led to a low incidence of acute rejection and a high graft survival rate across 30 years of pediatric transplantation.

Outcomes of pediatric deceased donor kidney transplant in northeast Thailand

“…In this study, the majority of KT recipients were male, and the most common etiology of ESRD was congenital anomalies of the kidneys and urinary tract, both of which are consistent with previously published reports 3–10 . However, there were no patients with ESRD caused by obstructive uropathy, which is more common in boys.…”

“…3,10 Although several agents have recently emerged for renal rejection therapy, drug availability, expense, and efficacy limit their usage. The rates of early graft and patient survival in this study were comparable to those in previous reports; 3,4,7,8 however, long-term outcomes, especially after the patient is transferred to the adult unit, require further examination.…”

Graft and Patient Survival Rate among Iranian Pediatric Recipients of Kidney Transplantation: A Systematic Review and Meta-Analysis

“…Interestingly, 1-year survival rate was reported 94%, which is even higher. In Japan, this survival rate was 81%, which is much less than the result obtained in this study ( 29 ). The one-year survival rate of kidney transplant patients was 100%, while in Egypt; the rate was reported to be 94% ( 26 ).…”

Incidence of malignancy after pediatric kidney transplantation: a single-center experience over the past three decades in Japan

“…Since 2002 (era 3), new immunosuppression regimens were introduced. Standard immunosuppression consisted of induction with basiliximab and triple therapy with MPL, CyA or Tac, and mycophenolate mofetil (MMF) [ 10 ]. CyA and Tac were generally alternated in patients rather than randomized.…”