Failure to Thrive after Pediatric Kidney Transplantation
1Children's National, Washington DC
2John's Hopkins, Baltimore.
Meeting: 2018 American Transplant Congress
Abstract number: B235
Keywords: Growth disorders, Weight
Session Information
Session Name: Poster Session B: Kidney: Pediatrics
Session Type: Poster Session
Date: Sunday, June 3, 2018
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall 4EF
Background: After kidney transplant (tx), children are expected to thrive, however in a subset this does not occur. Causes and implications of post-tx failure to thrive (FTT) are not well understood.
Objective: A retrospective cohort study was conducted to determine factors associated with FTT and association of FTT with adverse outcomes (hospitalization and infection).
Methods: Records of 119 children consecutively transplanted between 2005-2016 were reviewed. FTT was defined as ≥2 of the following: 1) low body mass, 2) poor weight gain 3) poor growth, or 4) chronic hypoalbuminemia at 1 or 3 years post-tx. Logistic regression was used to identify factors associated with FTT and poisson regression for association of FTT with outcomes at 1 and 3 years.
Results: Prevalence of FTT was 22% and 18% at 1 and 3 years. Factors associated with FTT shown in Table 1. Odds of FTT decreased by 0.5 for each 1 unit increase in pre-tx BMI z-score. Clean intermittent catheterization (CIC) conferred 3.8 and 7.8 times odds of FTT at 1 and 3 years. FTT at 1 year increased odds of FTT at 3 years. In patients with FTT, infections increased 2.7 and 4.2 times and hospitalizations increased 2.6 and 4.3 times at 1 and 3 years (p<0.0006).
| Table 1. Risk factors associated with FTT
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| Bivariate Analysis | FTT at 1 year (n=119) | FTT at 3 years (n=84) |
| Pre-tx variables | p value | p value |
| Gtube dependence | 0.01* | 0.02* |
| Low BMI | 0.01* | 0.04* |
| Low height | 0.02* | 0.008* |
| Duration dialysis | 0.002*** | 0.02*** |
| Post-tx variables | ||
| Deceased vs. living donor | 0.03** | 0.50 |
| MMF intolerance | 0.009* | 0.23 |
| CIC | 0.04* | 0.02* |
| Low hemoglobin | 0.03* | 0.03* |
| Vitamin D deficiency | 0.13 | 0.03* |
| Multivariate analysis | Odds Ratio (95%CI) | |
| Pre-tx BMI z-score | 0.5 (0.3-0.8)# | NS |
| CIC | 3.8 (1.04-14.2)# | 7.8 (1.04-58.4)# |
| FTT at 1 year | NA | 61.1 (7.8-478)# |
| Significant (bivariate)
*Pearson chi-square **Fisher's exact ***t-test Not significant: dialysis modality, glomerular disease, donor specific antibody, steroids, age, sex, race Significant (multivariate) #logistic regression: adjusted for age, sex, race, eGFR |
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Conclusion: Children with low BMI pre-tx and those requiring CIC post-tx are at increased risk for post-tx FTT. FTT is associated with adverse outcomes, evidenced by increased infection and hospitalization.
CITATION INFORMATION: Sgambat K., Cheng Y., Charnaya O., Moudgil A. Failure to Thrive after Pediatric Kidney Transplantation Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:
Sgambat K, Cheng Y, Charnaya O, Moudgil A. Failure to Thrive after Pediatric Kidney Transplantation [abstract]. https://atcmeetingabstracts.com/abstract/failure-to-thrive-after-pediatric-kidney-transplantation/. Accessed November 23, 2024.« Back to 2018 American Transplant Congress