Survival Advantage of Pediatric Recipients of a First Kidney Transplant Among Children Awaiting Kidney Transplantation

Gillen, Daniel L.; Stehman‐Breen, Catherine; Smith, Jodi M.; McDonald, Ruth A.; Warady, Bradley A.; Brandt, John R.; Wong, Craig S.

doi:10.1111/j.1600-6143.2008.02410.x

Cited by 105 publications

(58 citation statements)

References 16 publications

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“…The higher mortality risk in females compared with males has also been noted previously among pediatric recipients of deceased donor transplants (5). The mechanisms explaining this gender difference deserve additional study.…”

Section: Discussionsupporting

confidence: 62%

“…In adults, graft failure with return to dialysis was also associated with a more than threefold higher risk of death from any cause than continued graft function (17). A substantially higher mortality risk in the 3-to 12-month period following transplantation was previously shown in adults (4,6,16) and children (5). In our study, mortality risk beyond the first year of a second transplant was only modestly higher (23%) than the risk beyond the first year of a first transplant.…”

Section: Discussionsupporting

confidence: 54%

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Change in Mortality Risk Over Time in Young Kidney Transplant Recipients

Foster

Dahhou

Zhang

et al. 2011

American Journal of Transplantation

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Mortality risk for kidney transplant recipients may change with increasing accumulated exposure to the "transplantation milieu." We sought to characterize changes over time in mortality rate and in age-, sexand race-standardized mortality ratios (SMR) relative to the general population, and to estimate the association between increasing time since first transplant and mortality risk. A total of 18 911 patients who received a first transplant at <21 years old (1983-2006), and whose data were recorded in the USRDS, were studied. There were 2713 deaths over a median followup of 8.9 (interquartile range 4.0-14.5; maximum 23) years. Among those with graft function, mortality was highest in the first post transplant year; beyond the first year of the first transplant, age-adjusted mortality rates and SMRs decreased slightly over follow-up. Cause of death was cardiovascular for 34.6%, infection for 19.5%, malignancy for 5.8%, other for 21.4% and unknown for 18.7%. For every 1-year time increment after the end of the first post transplant year, ageadjusted all-cause and cardiovascular mortality rates fell by 1% (p = 0.06) and 16% (p = 0.007), respectively; infection-related mortality rate did not change over time (p = 0.5). These results suggest that exposure to the transplantation milieu has no cumulative negative effects on cardiovascular health over the long term.

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Section: Discussionsupporting

confidence: 62%

Section: Discussionsupporting

confidence: 54%

Change in Mortality Risk Over Time in Young Kidney Transplant Recipients

Foster

Dahhou

Zhang

et al. 2011

American Journal of Transplantation

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“…Kidney transplantation is the treatment of choice for children with ESRD, providing a significant survival advantage over dialysis (1,2). However, there is a critical shortage of deceased-donor organs available for kidney transplantation.…”

Section: Introductionmentioning

confidence: 99%

Late Graft Loss among Pediatric Recipients of DCD Kidneys

Arendonk

James

Locke

et al. 2011

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Kidney transplantation from donors after cardiac death (DCD) provides similar graft survival to donors after brain death (DBD) in adult recipients. However, outcomes of DCD kidneys in pediatric recipients remain unclear, primarily because of limited sample sizes.Design, setting, participants, & measurements We identified 137 pediatric (Ͻ18 years old) recipients of DCD kidneys between 1994 and 2010 using Scientific Registry of Transplant Recipients data and compared outcomes with 6059 pediatric recipients of DBD kidneys during the same time period, accounting for donor, recipient, and transplant characteristics using time-varying Cox regression and matched controls. Long-term follow-up (4 years or beyond) was available for 31 DCD recipients.Results Pediatric recipients of DCD kidneys experienced a significantly higher rate of delayed graft function (22.0% versus 12.3%; P ϭ 0.001), although lower than reported delayed graft function rates of DCD grafts in adults. Although DCD and DBD graft survival was equal in the early postoperative period, graft loss among pediatric recipients of DCD kidneys exceeded their DBD counterparts starting 4 years after transplantation. This effect was statistically significant in a multivariate Cox model (hazard ratio ϭ 2.03; 95% confidence interval, 1.21 to 3.39; P ϭ 0.007) and matched-controls analysis (hazard ratio ϭ 2.36; 95% confidence interval, 1.11 to 5.03; P ϭ 0.03).Conclusions A significant increase in DCD graft loss starting 4 years after transplantation motivates a cautious approach to the use of DCD kidneys in children, in whom long-term graft survival is of utmost importance.

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“…1 Kidney transplantation (KT) has emerged as the optimal treatment of pediatric patients with ESRD, providing a significant survival advantage over dialysis. 1,2 Approximately 800 children in the United States undergo KT each year, representing about 5% of all kidney transplants performed nationally. 3 The field of pediatric KT has evolved over the past 25 years, including changes in immunosuppression, surgical technique, organ allocation policy, and rates of living donor transplantation.…”

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confidence: 99%

National Trends Over 25 Years in Pediatric Kidney Transplant Outcomes

et al. 2014

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WHAT'S KNOWN ON THIS SUBJECT: Kidney transplantation is the optimal treatment of children with end-stage renal disease. The field of pediatric kidney transplantation has changed over time with regard to immunosuppression, surgical technique, organ allocation policy, and rates of living donor transplantation. WHAT THIS STUDY ADDS:Outcomes after pediatric kidney transplantation in the United States have improved over time, independent of changes in recipient, donor, and transplant characteristics. These improvements were most dramatic within the first posttransplant year and among the most highly sensitized patients. abstract OBJECTIVE: To investigate changes in pediatric kidney transplant outcomes over time and potential variations in these changes between the early and late posttransplant periods and across subgroups based on recipient, donor, and transplant characteristics. METHODS:Using multiple logistic regression and multivariable Cox models, graft and patient outcomes were analyzed in 17 446 pediatric kidneyonly transplants performed in the United States between 1987 and 2012.RESULTS: Ten-year patient and graft survival rates were 90.5% and 60.2%, respectively, after transplantation in 2001, compared with 77.6% and 46.8% after transplantation in 1987. Primary nonfunction and delayed graft function occurred in 3.3% and 5.3%, respectively, of transplants performed in 2011, compared with 15.4% and 19.7% of those performed in 1987. Adjusted for recipient, donor, and transplant characteristics, these improvements corresponded to a 5% decreased hazard of graft loss, 5% decreased hazard of death, 10% decreased odds of primary nonfunction, and 5% decreased odds of delayed graft function with each more recent year of transplantation. Graft survival improvements were lower in adolescent and female recipients, those receiving pretransplant dialysis, and those with focal segmental glomerulosclerosis. Patient survival improvements were higher in those with elevated peak panel reactive antibody. Both patient and graft survival improvements were most pronounced in the first posttransplant year. CONCLUSIONS:Outcomes after pediatric kidney transplantation have improved dramatically over time for all recipient subgroups, especially for highly sensitized recipients. Most improvement in graft and patient survival has come in the first year after transplantation, highlighting the need for continued progress in long-term outcomes. The field of pediatric KT has evolved over the past 25 years, including changes in immunosuppression, surgical technique, organ allocation policy, and rates of living donor transplantation. 4 However, the relationship between these changes and post-KT outcomes remains unclear, both in terms of which patient phenotypes have been affected and when any changes in outcomes have occurred (ie, early versus late post-KT).The objective of this study was to examine changes in pediatric KToutcomes over the last 25 years. In particular, our work sought to assess trends in graft survival, rates of primary nonfunct...

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Survival Advantage of Pediatric Recipients of a First Kidney Transplant Among Children Awaiting Kidney Transplantation

Cited by 105 publications

References 16 publications

Change in Mortality Risk Over Time in Young Kidney Transplant Recipients

Change in Mortality Risk Over Time in Young Kidney Transplant Recipients

Late Graft Loss among Pediatric Recipients of DCD Kidneys

National Trends Over 25 Years in Pediatric Kidney Transplant Outcomes

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