Risk Factors for Acute Cellular Rejection for Pediatric Kidney Transplant Recipients
1Department of Surgery, Case Western Reserve University & University Hospitals, Cleveland, OH
2Department of Pediatrics, Case Western Reserve University & University Hospitals, Cleveland, OH.
Meeting: 2015 American Transplant Congress
Abstract number: D206
Keywords: Kidney transplantation, Pediatric, Rejection, Risk factors
Session Information
Session Name: Poster Session D: Pediatric Clinical Kidney Transplantation
Session Type: Poster Session
Date: Tuesday, May 5, 2015
Session Time: 5:30pm-6:30pm
Presentation Time: 5:30pm-6:30pm
Location: Exhibit Hall E
Background: Acute cellular rejection (ACR) potentially shortens the life of a kidney allograft. We sought to determine risk factors associated with the development of ACR in our pediatric population following kidney transplantation.
Methods: Following IRB approval, we retrospectively analyzed the outcomes of children who underwent kidney transplantation at a single institution between 2000 and 2013. To evaluate factors associated with ACR, we used univariate and multivariate logistic regression analysis to predict the occurrence of ACR episodes.
Results: Of 73 children who underwent kidney transplantation, 45 (62%) were male, 54 (74%) were Caucasian, and 12 (16%) were African-American. Age at transplant ranged from 1.7 to 18.8 years. Fifty-five (75.3%) allografts were from living donors (47 live-related, 8 live-unrelated). Causes of end-stage renal disease included congenital anomalies of the kidney and urinary tract (CAKUT, n=38), FSGS (n=11), other glomerular disease (n=11), and other causes (n=13). Biopsy-proven ACR was diagnosed in 23 patients (31.5%) at a median time of 23 months posttransplant. On univariate logistic regression analysis, black race, FSGS diagnosis, male gender, posttransplant CMV infection, and increased donor age predicted acute rejection episodes, while a diagnosis of CAKUT was associated with a lower risk of acute rejection episodes. In a multivariate analysis, black race (OR 14.9, CI 2.7-83, p=.002) and FSGS diagnosis (OR 7.7, CI 1.5-39, p=.014) remained significant risk factors. On review of 63 charts with available progress notes, 33 (52%) included provider suspicion or patient admission of immunosuppression nonadherence with a significantly higher rate in ACR patients than in non-ACR patients (74% versus 40%, respectively; p=.017).
Conclusion: Pediatric kidney recipients have many of the same risk factors for ACR as older patients. In our pediatric population, FSGS and black race were important predictors of ACR. Pediatric kidney recipients with defined risk factors for ACR should be monitored closely.
To cite this abstract in AMA style:
Cote D, Bobanga I, Vogt B, Dell K, III RCunningham, Noon K, Humphreville V, Sanchez E, Schulak J, Woodside K. Risk Factors for Acute Cellular Rejection for Pediatric Kidney Transplant Recipients [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/risk-factors-for-acute-cellular-rejection-for-pediatric-kidney-transplant-recipients/. Accessed May 19, 2025.« Back to 2015 American Transplant Congress