The 1989 report of the North American Pediatric Renal Transplant Cooperative Study

Abstract

This report of the North American Pediatric Transplant Cooperative Study summarizes data contributed by 57 participating centers on 754 children with 761 transplants from 1 January 1989 to 16 February 1989. Data collection was initiated in October 1987 and follow-up of all patients is ongoing. Transplant frequency increased with age; 24% of the patients were less than 5 years, with 7% being under 2 years. Common frequent diagnoses were: aplastic/dysplastic kidneys (18%), obstructive uropathy (16%), and focal segmental glomerulosclerosis (12%). Preemptive transplant, i.e., transplantation without prior maintenance dialysis, was performed in 21% of the patients. Dialytic modalities pretransplant were peritoneal dialysis in 42% and hemodialysis in 25%. Bilateral nephrectomy was reported in 29%. Live-donor sources accounted for 42% of the transplants. Among cadaveric donors, 41% of the donors were under 11 years old. During the first post-transplant month, maintenance therapy was used similarly for live-donor and cadaver source transplants, with prednisone, cyclosporine, and azathioprine used in 93%, 83%, and 81%, respectively. Triple therapy with prednisone, cyclosporine, and azathioprine was used in 78%, 75%, and 75% of functioning cadaver source transplants at 6 months, 12 months, and 18 months as opposed to 60%, 63%, and 54% for live-donor procedures, with single-drug therapy being uncommon. Rehospitalization during months 1-5 occurred in 62% of the patients, with treatment of rejection and infection being the main causes. Additionally, 9% were hospitalized for hypertension. During months 6-12 and 12-17, 30% and 28% of the patients with functioning grafts were rehospitalized. Times to first rejection differed significantly for cadaver and live-donor transplants. The median time to the first rejection was 36 days for cadaver transplants and 156 days for live-donor transplants. Overall, 57% of treated rejections were completely reversible although the complete reversal rate decreased to 37% for four or more rejections. One hundred and fifty-two graft failures had occurred at the time of writing, with a 1-year graft survival estimate of 0.88 for live-donor and 0.71 for cadaver source transplants. In addition to donor source, recipient age is a significant prognostic factor for graft survival. Among cadaver donors, decreasing donor age is associated with a decreasing probability of graft survival. Thirty-five deaths have occurred; 16 attributed to infection and 19 to other causes. The current 1-year survival estimate is 0.94. There have been 9 malignancies.

Post-Transplant Infections Now Exceed Acute Rejection as Cause for Hospitalization: A Report of the NAPRTCS

“…Data collection methods have been described previously (5). Briefly, extensive data are collected at the time of enrollment, at 1 month post-transplantation, at 6 months post-transplantation, and at every 6 months thereafter.…”

Racial differences in the incidence and renal outcome of idiopathic focal segmental glomerulosclerosis in children

“…Although data from the pediatric population are not available, however, certain inferences can be made from the North American Pediatric Renal Transplant Cooperative Study [9]. The Registry (1987)(1988)(1989) reported that black and Hispanic children accounted for 23% of all kidney transplants but 38% of renal transplants in which FSGS was the cause of ESRD [9]. These findings suggested that black and Hispanic children experience a disproportionate frequency of FSGS with progression to ESRD, hence we analyzed our Single-center experience of FSGS comparing white arid non,white children.…”

“…The incidence of ESRD in non-white patients was 2.7 times higher than in white patients in a national survey [8]. Although data from the pediatric population are not available, however, certain inferences can be made from the North American Pediatric Renal Transplant Cooperative Study [9]. The Registry (1987)(1988)(1989) reported that black and Hispanic children accounted for 23% of all kidney transplants but 38% of renal transplants in which FSGS was the cause of ESRD [9].…”

Clinical effectiveness and cost-effectiveness of tests for the diagnosis and investigation of urinary tract infection in children: a systematic review and economic model

“…256 The probability of developing ESRD for children who experienced PRS was based on registry data. 257 The age at which children will develop ESRD is uncertain; therefore, this is represented by a distribution of ages (7-24 years) based on evidence reported in two observational studies. 258,259 Two consequences of ESRD are considered, transplant and long-term home dialysis.…”