Background: Long-term graft function has not kept pace with short-term graft survival in children. Late Acute Rejection (LAR) episodes are in part responsible for the lack of long-term graft survival. The risk factors for LAR in pediatric & adolescent in kidney transplant (Tx) recipients are not well defined

Objective: To identify the determinants for LAR in pediatric & adolescent kidney Tx recipients

Design/Methods: A retrospective analysis of pediatric & adolescent kidney Tx recipients ≤21 yrs of age at the time of Tx between July 1,2005 & June 30,2011 with at least 1 yr follow-up. Of 73 Tx recipients, 64 were included in the analysis. 9 recipients were excluded for either graft loss or early acute rejection(occurring ≤6 months post-Tx). The included patients were divided into 2 cohorts; control group-41 & LAR group-23 patients(≥6 months at time of rejection). Donor-Specific Antibodies (DSA) were obtained at the time of clinical suspicion of LAR.

Results: LAR was diagnosed by clinical & histological criteria in 23(35.9%) Tx recipients. Mean age at Tx was not different in the groups(13.3±5.2 yrs in controls vs. 12.6±5.6 yrs in LAR). Mean age at the time of LAR was 14.7±4.8 yrs with 60.8% ≥12 yrs of age. Mean follow-up period was 31.2(3.9-79) months. Significant clinical & demographic factors that were associated with LAR by univariate analyses in the cohort are shown below.

Other variables with p<0.10 in univariate analyses were included in multivariate logistic-regression analyses with the odds ratio of each variable shown below.

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