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1000 Pediatric Kidney Transplants-A Single Center Experience

S. Chinnakotla, B. Chavers, P. Verghese, M. Rheault, C. Najera, T. Nevins, C. Kashtan, M. Mauer, K. Gillingham, J. Najarian, A. Matas

Surg, U Mn, Mpls, MN
Ped Nephrol, U Mn, Mpls

Meeting: 2013 American Transplant Congress

Abstract number: C1419

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Objective: To study outcomes and risk-factors for graft-loss in > 1000 pediatric kidney transplants.

Methods: We studied outcomes by immunosuppression era: I) 1963-83 (ATG, Imuran and steroids); II) 1984-2001 (introduction of CNIs); and III) 2001-present (steroid avoidance).

Results: 1010 transplants (Age<1yr=53, 1-2yr=124, 3-5yr=182, 6-10yr=216, 11-18=435) were done. (810 Ist; 200 retx) (LD=69%, DD=31%; 3% LURDs pre-2001, 17% since [p<.01]). Congenital-anomalies were the commonest indication (Table 1) Ten-yr actuarial patient-survival (p <0.001), graft survival (p=0.0005), and death-censored graft-survival (p=.02) steadily improved by era (Table 1). Graft half-life (starting @ 1 yr posttx) is 33 years for LDs, 14 years for DDs. Graft-loss for all causes < 1 year posttx has ⇓ by era (Table 1); from 1-5 yrs, CR/IFTA remains predominant. For the entire cohort, by multivariate-analysis, LD(p<.0001) and Era III (vs I and II) (p<.0003) had better survival.↑ LD donor age did not affect graft survival.Risk-factors for loss varied by era (Table 2). Successful transplant was associated with improved QoL, and return-to-school and (subsequently) work.

Conclusions: Long term Outcomes of pediatric renal transplantation have continued to improve. LD grafts provide the most benefit and should be the first option.

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To cite this abstract in AMA style:

Chinnakotla S, Chavers B, Verghese P, Rheault M, Najera C, Nevins T, Kashtan C, Mauer M, Gillingham K, Najarian J, Matas A. 1000 Pediatric Kidney Transplants-A Single Center Experience [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/1000-pediatric-kidney-transplants-a-single-center-experience/. Accessed April 21, 2021.

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    Table 1
      Era I 1963-1983 (n=362) Era II 1984-2001 (n=451) Era III 2001-2012 (n=197)
    Indication for Transplant
    Congenital Anomalies 60(17%) 95(21%) 52(26%)
    Obstructive Nephropathy 52(15%) 81(18%) 28(20%)
    Congenital Nephrotic Syndrome 34(9.4%) 36(8%) 9(5%)
    FSGS Steriod Resistan 23(6%) 35(7%) 23(11%)
    GN-CGN 53(15%) 7(1.5%) 0
    10-Year Patient Survival (%)
    LD 76 92 94
    DD 66 94 100
    10-Year Graft Survival (%)
    LD 49 65 75
    DD 31 43 57
    Causes of Graft Loss < 1 Year (%)
    Acute Rejection 8 2 0.6
    Chronic Rejection/CAN 5 1 0.6
    Recurrence 2 2 1
    Technical/Thrombosis 3 4 2
    DWF 5 1 1
    Functioning 75 88 95
    Causes of Graft Loss 1-5 Years (%)
    Acute Rejection 0.7 0.8 2
    Chronic Rejection/CAN 14 10 6
    Recurrence 2 2 1
    Non Compliance 0.4 2 2
    DWF 6 1 2