Purpose: Kidney transplantation (KTx) is the preferred treatment for children with ESRD. Although the steady advances in immunosuppression have enabled control of early acute rejection (AR), long-term graft survival remains unclear. We analyzed long-term outcome and risk factors for graft loss, with a change in immunosuppression over the past 3 decades.

Methods: In this retrospective cohort study, we reviewed the medical charts from 400 consecutive KTx performed in 377 children between 1975 and 2009. Patients were stratified into three eras according to the introduction of immunosuppressive regimen. Era 1 (1975-1985): methylprednisolone (MP) and azathioprine (AZA) (n=118); Era 2 (1986-2001): Calcineurin inhibitors (CNIs) based therapy, including MP and AZA or mizoribine (n=161); Era 3 (2002-2009): basiliximab induction therapy, including CNIs, MP and mycophenolate mofetil (n=121). ABO-incompatible KTx (ABO-incKTx)has been performed since 1989.

Results: The median age was 9 years (IQR 5-13) and median body weight was 21kg (IQR 14-32). The most common indications were congenital anomalies. 371 cases underwent dialysis, the median at duration of dialysis was 1.9 years (IQR 1.0-3.6). 364 cases were living related donor and 31 cases were ABO-incKTx. The median period of post KTx was 15 years (IQR 10-23). Patient survival was 97, 96, 93, 88 and 81% at 1, 5, 10, 20 and 30 years post KTx, respectively. The overall graft survival was 92, 82, 72, 50 and 34% at 1, 5, 10, 20 and 30 years post KTx, respectively.Graft survival of ABO-incKTx at 1, 5, 10, and 20 years post KTx were 94, 90, 90 and 70%, respectively. Ten-year graft survival by Era 1 to 3 was 47, 79 and 89%, respectively. The graft half-life by Era 1 and 2 was 9.7 years and 26.9 years. AR was the most common cause of graft loss within 1 year post KTx. The incidence of AR decreased significantly in Era 3, as compared with Era 1 and 2. Based on the Cox multivariate analysis, cold ischemic time (HR: 1.0, CI: 1.001-1.003) and AR (HR: 1.3, CI: 1.1-1.5) were associated with an increased risk of graft loss.

Conclusions: Graft survival in pediatric KTx has improved during the past 3 decades with immunosuppressive regimen. Moreover, ABO-incKTxhas been achieved excellent long-term outcome.

CITATION INFORMATION: Aoki Y., Satoh H., Matsui Z., Hamada R., Hamasaki Y., Shishido S. Long-Term Outcome of Pediatric Kidney Transplantation: A Single-Center Experience over the past Three Decades in Japan Am J Transplant. 2017;17 (suppl 3).

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