Differences in Graft Survival for Pediatric and Adult Kidney Recipients Followed and Lost to Follow-Up
1United Network for Organ Sharing, Richmond, VA, 2Seattle Children's Hospital, Seattle, WA, 3University of Wisconsin Hospital and Clinics, Madison, WI, 4Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA
Meeting: 2019 American Transplant Congress
Abstract number: C241
Session Information
Session Name: Poster Session C: Kidney: Pediatrics
Session Type: Poster Session
Date: Monday, June 3, 2019
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall C & D
*Purpose: While the majority of kidney transplant recipients are followed by their program, many end up reported to the OPTN as lost to follow-up (LTFU). Outcomes for some LTFU patients who die or return to the waiting list can be identified in national databases, but not for those living with functioning grafts. This was of particular concern for the OPTN Pediatric Committee, as pediatric recipients have decades of graft function ahead of them after receiving a transplant.
*Methods: We queried the OPTN database for all kidney recipients between 2000 and 2006. Recipients who returned to the waiting list as of December 2016 were identified, and deceased recipients were identified from external sources. Recipients who returned to dialysis after being followed for at least three years were identified using CMS Medical Evidence Form 2728. LTFU rates were calculated using the competing risks extension of Kaplan Meier survival. Time to dialysis or relisting was analyzed using death-censored Kaplan Meier estimation, including follow-up status as a time dependent strata.
*Results: We identified 92,879 kidney recipients transplanted from 2000 to 2006. Of these, 15,130 were LTFU within 10 years of transplant. LTFU rates (Figure 1A) were highest for recipients 12-17y (rate [95% CI]: 22%[21-24%]) and 18-34y at transplant (22% [21-23%]). LTFU rates were lower for older recipients due to their increased likelihood of dying. For recipients aged 12-17, 14% [95%CI: 9-19%] of lost recipients were relisted compared to 38% [36-40%] of followed recipients, and 19% [16-23%] of lost recipients returned to dialysis compared to 35% [33-37%] of followed recipients (Figure 1B-C). Similarly, 18% [13-23%] of lost recipients aged 18-34 were relisted compared to 31% [30-31%] of followed recipients, and 14% [13-16%] of lost recipients returned to dialysis compared to 26% [25-27%] of followed recipients.
*Conclusions: Adolescent and young adult kidney recipients are at higher risk of being LTFU than other ages. Recipients under the age of 50 are at lower risk of relisting or returning to dialysis if they are LTFU than followed recipients. While it is not specified where recipients LTFU are receiving care, this difference in graft survival implies lost recipients get sufficient care to maintain their graft. Conversely, patients who are followed may have other health problems requiring care which also put them at higher risk of graft failure.
To cite this abstract in AMA style:
Robinson AM, Hsu EK, Bartosh SM, Stewart DE, Mazariegos GV. Differences in Graft Survival for Pediatric and Adult Kidney Recipients Followed and Lost to Follow-Up [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/differences-in-graft-survival-for-pediatric-and-adult-kidney-recipients-followed-and-lost-to-follow-up/. Accessed May 11, 2025.« Back to 2019 American Transplant Congress