The prevalence and outcome of children with failure to thrive after pediatric kidney transplantation

Abstract

Background Prior to transplantation, effects of advanced CKD contribute to malnutrition and impaired growth. After transplant, children are expected to thrive, however, in a subset of transplant recipients this does not occur. Factors associated with post‐transplant FTT are poorly understood. Objective A retrospective cohort study was conducted to determine factors associated with FTT and association of FTT with infections and hospitalizations. Methods Records of 119 children transplanted between 2005 and 2016 were reviewed. FTT was defined by ≥2 of the following post‐transplant criteria: (a) low BMI or deceleration in BMI z‐score, (b) poor growth velocity, and (c) chronic hypoalbuminemia at 1 or 3 years post‐transplant. Association of FTT with deceased donor transplant, de novo DSA, intolerance to MMF, anemia, vitamin D deficiency, and CIC was investigated by logistic regression. Poisson regression was used to identify outcomes associated with FTT. Results Low pre‐transplant BMI and post‐transplant CIC dependence were independently associated with FTT after transplant. Odds of FTT at 1 year post‐transplant decreased by 0.5 for each 1 unit increase in pre‐transplant BMI z‐score. Requirement for CIC conferred 3.8 and 7.8 higher odds of FTT at 1 and 3 years. Patients with FTT had 2.7 and 2.6 times infections and hospitalizations during the first year, and 4.2 and 4.3 times infections and hospitalizations over 3 years post‐transplant. Conclusions Children with low BMI prior to transplant and those requiring CIC after transplant are at increased risk for post‐transplant FTT. FTT is associated with adverse outcomes, evidenced by increased infections and hospitalizations.

Prevalence of renal pathological disorders in kidney transplant recipients: an observational study in the north of Iran

“…Nowadays, chronic kidney disease (CKD) has been introduced as one of the most common chronic diseases and a global burden on the healthcare system (1). According to the definition of Kidney Disease Improving Global Outcomes (KDIGO), the presence of glomerular filtration rate (GFR) of less than 60 mL/min and albumin of more than 30 mg per a gram of creatinine along with abnormalities of kidney structure and function for more than three months indicates CKD (2,3). The global prevalence of this disease is estimated to be about 13.4% (4).…”

“…The global prevalence of this disease is estimated to be about 13.4% (4). End-stage renal disease (ESRD) is the last stage of CKD which is defined as a GFR of less than 15 mL/ min (2,3). This disease is progressive and irreversible, in which the body has an inability to maintain the balance of fluids and electrolytes, leading to uremia and azotemia.…”

Orofacial pigmentation in hemodialysis patients: A Case Control Study

“…CKD has been defined by the Kidney Disease Improving Global Outcomes (KDIGO) foundation guidelines as the presence of both of these factors (glomerular filtration rate [GFR] less than 60 mL/ min and albumin greater than 30 mg per gram of creatinine) along with defects of kidney structure or function for greater than three months. Furthermore, ESRD is defined as a GFR of less than 15 mL/ min [10,11] .…”

Undernutrition and Hypoleptinemia Modulate Alloimmunity and CMV-specific Viral Immunity in Transplantation

“…Infections are a significant cause of morbidity in pediatric transplantation, especially in the undernourished population. [1][2][3][4] Undernourished children have an increased risk of posttransplant viremia, viral infections, 3,5 and death, 1,6 which can all result in premature allograft failure 7,8 compared with their nourished counterparts. Importantly, cytomegalovirus (CMV) infection remains a significant posttransplant complication with an incidence of up to 30% in pediatric solid organ transplantation.…”