Validation of serum creatinine-based formulae in pediatric renal transplant recipients

Alkandari, Omar; Hébert, Diane; Langlois, Valérie S.; Robinson, Lisa A.; Parekh, Rulan S.

doi:10.1038/pr.2017.209

Cited by 13 publications

(6 citation statements)

References 37 publications

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“…eGFR was calculated using the modified Schwartz formula. 10 Acute rejection episodes captured all biopsyproven acute rejection events, including borderline cellular rejection, acute cellular rejection, and antibody-mediated rejection. Neutropenia was defined as an absolute neutrophil count < 1500/mm 3 .…”

Section: Data Collectionmentioning

confidence: 99%

Low-Dose Antithymocyte Globulin Has No Disadvantages to Standard Higher Dose in Pediatric Kidney Transplant Recipients: Report From the Pediatric Nephrology Research Consortium

Ashoor

Beyl

Gupta

et al. 2021

Kidney International Reports

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Introduction: Rabbit antithymocyte globulin (rATG) dosing strategies for induction in pediatric kidney transplantation vary between centers. It is not known whether a lower rATG induction dose provides safe and effective immunosuppression compared with a "standard" higher dose. Methods: We performed a retrospective multicenter study of all isolated first-time kidney transplant recipients <21 years old who received rATG induction between 1 January 2010 and 31 December 2014 at 9 pediatric centers. An a priori cutoff of a 4.5-mg/kg cumulative rATG dose was used to identify low (# 4.5 mg/kg) and standard (> 4.5 mg/kg) exposure groups. Outcomes examined included 12 months posttransplant graft function (estimated glomerular filtration rate [eGFR]); the occurrence of acute rejection, donor-specific antibody (DSA), neutropenia, and viral infection (cytomegalovirus [CMV], Epstein-Barr virus [EBV], and BK virus); and 24-month outcomes of posttransplant lymphoproliferative disorder (PTLD) occurrence and patient and graft survival. Results: Two hundred thirty-five patients were included. Baseline features of the low and standard rATG dose groups were similar. By 12 months, the rATG dose group had no significant impact on the occurrence of neutropenia, positive DSA, or viral polymerase chain reaction (PCR). Graft function was similar. Acute rejection rates were similar at 17% (low dose) versus 19% (standard dose) (P ¼ 0.13). By 24 months, graft survival (96.4% vs. 94.6%) and patient survival (100% vs. 99.3%) were similar between the low-and standard-dose groups (P ¼ 0.54 and 0.46), whereas the occurrence of PTLD trended higher in the standarddose group (0% vs. 2.6%, P ¼ 0.07). Conclusion: A low rATG induction dose # 4.5 mg/kg provided safe and effective outcomes in this multicenter low immunologic risk pediatric cohort. Prospective studies are warranted to define the optimal rATG induction dose in pediatric kidney transplantation.

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Section: Data Collectionmentioning

confidence: 99%

Low-Dose Antithymocyte Globulin Has No Disadvantages to Standard Higher Dose in Pediatric Kidney Transplant Recipients: Report From the Pediatric Nephrology Research Consortium

Ashoor

Beyl

Gupta

et al. 2021

Kidney International Reports

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“…However, a more accurate assessment of GFR using inulin clearance or nuclear GFR is not always practical and carries its own limitations. In addition, we recently validated the modified Schwartz formula in pediatric kidney transplant recipients (49,50). Moreover, most of the children were not hospitalized at the time of onset of AKI; thus, we were unable to obtain a baseline creatinine within 7 days of onset of AKI in many of the AKI episodes as per the KDIGO guideline's creatinine baseline definition.…”

Section: Discussionmentioning

confidence: 99%

Acute Kidney Injury in Children with Kidney Transplantation

Alkandari

Nguyen

Hébert

et al. 2018

CJASN

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Background and objectives AKI is associated with progression of CKD. Little is known about AKI after kidney transplantation in pediatric recipients. We aim to describe the epidemiology, risk factors, consequences, and outcomes of AKI in this population. Design, setting, participants, & measurements We performed a retrospective longitudinal analysis of pediatric kidney transplant recipients followed at The Hospital for Sick Children (Toronto, Canada) from 2001 to 2012. AKI was defined as an increase in serum creatinine $1.5 times baseline, and a rise of serum creatinine $1.25 but ,1.5 times baseline defined subacute AKI. Results Of 179 children, 122 were eligible for analysis. At baseline (3 months post-transplant), median age of the children was 13 years old (interquartile range, 9-16 years old), and 53% had CKD stage 2. Congenital anomalies of the kidney and urinary tract accounted for 46% of children. Over the study period (12 years), the incidence of AKI was 37% (n=45 children), and 65% (79 children) experienced subacute AKI. Twenty-seven percent (33 children) did not develop AKI or subacute AKI. The main causes of AKI were infections other than urinary tract infections, rejection, and urinary tract infections. In a multivariable Poisson regression analysis, independent risk factors for AKI included younger age, girls, grafts from deceased donors, and lower baseline eGFR. AKI was significantly associated with lower long-term GFR and graft loss independent of rejection episodes. Moreover, subacute AKI was associated with progression of CKD. Conclusions AKI and subacute AKI were common after pediatric kidney transplantation, and they were associated with graft loss, lower eGFR, and more rapid progression of CKD.

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“…Primary outcome was time to first-acute kidney transplant rejection episode. Secondary outcomes included 6- and 12-month graft function as measured by the modified Schwartz formula in mL/min/1.73m2 as well as comparisons of graft and patient survival, 9 hospitalizations due to infections, and time to first-posttransplant lymphoproliferative disorder (PTLD) episode through 5 years post index kidney transplantation.…”

Section: Methodsmentioning

confidence: 99%

Reassessing Rabbit Antithymocyte Globulin Induction in Kidney Transplantation (RETHINK): An Analysis of the North American Pediatric Renal Trials and Collaborative Studies (NAPRTCS) Registry

Ashoor

Martz

Galbiati

et al. 2020

Transplantation Direct

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Background. There is no consensus on rabbit antithymocyte globulin (rATG) dose used for induction immunosuppression in pediatric kidney transplants. We aimed to identify whether a lower rATG dose provides safe and effective immunosuppression compared with a higher dose. Methods. We retrospectively analyzed all first-time kidney transplant recipients (aged <21 y) in the North American Pediatric Renal Trials and Collaborative Studies registry since 1998 on mycophenolate mofetil– and tacrolimus-based immunosuppression with rATG induction. An a priori cutoff of 7.5 mg/kg cumulative rATG dose was used to identify low (<7.5 mg/kg) and high (≥7.5 mg/kg) exposure groups. Primary outcome was time to first-acute rejection episode. Secondary outcomes included graft function, patient survival, hospitalizations due to infections, and time to first-posttransplant lymphoproliferative disorder episode. Results. Four hundred fifty-five patients met inclusion criteria (59% male, 49% whites, 26% blacks, 38% living donor source). Median cumulative rATG dose was 6.8 mg/kg with a median of 5 doses and a median 1.5 mg/kg/dose introduced at a median of postoperative 0 days. Sixty-four percent received <7.5 mg/kg total rATG. There was no difference in age at transplant, gender, race, end-stage renal disease causes, or HLA mismatch among groups. Time to first-acute rejection was similar (P = 0.07). There was no significant difference in graft or patient survival or time to posttransplant lymphoproliferative disorder. Hospitalization for infection rates was similar. Conclusions. These data demonstrate a wide variation in cumulative rATG induction dose. A smaller rATG dose <7.5 mg/kg may provide effective and safe immunosuppression compared with a higher dose.

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Validation of serum creatinine-based formulae in pediatric renal transplant recipients

Cited by 13 publications

References 37 publications

Low-Dose Antithymocyte Globulin Has No Disadvantages to Standard Higher Dose in Pediatric Kidney Transplant Recipients: Report From the Pediatric Nephrology Research Consortium

Low-Dose Antithymocyte Globulin Has No Disadvantages to Standard Higher Dose in Pediatric Kidney Transplant Recipients: Report From the Pediatric Nephrology Research Consortium

Acute Kidney Injury in Children with Kidney Transplantation

Reassessing Rabbit Antithymocyte Globulin Induction in Kidney Transplantation (RETHINK): An Analysis of the North American Pediatric Renal Trials and Collaborative Studies (NAPRTCS) Registry

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