Background. Pediatric kidney recipients must traverse a high-risk age window of late adolescence and early adulthood during which there is an increased risk of graft loss. Although this finding is typically attributed to immunosuppression non-adherence, which should affect all organ transplants, it is not clear whether recipients of other organs do in fact experience this same phenomenon.

Methods. Using SRTR data from 1987-2012, the risk of graft loss across age was quantified among pediatric kidney (n=17,446) and liver (n=12,161) transplants by plotting hazard functions across current recipient age, using age 0 as the time origin with late entries into the risk set conditioned on a minimum graft survival of six months. A multivariable piecewise-constant hazard rate model was used to compare hazard between intervals of current recipient age.

Results. After pediatric kidney transplantation, the risk of graft loss during late adolescence and early adulthood (ages 17-24 years) was significantly greater than during ages <17 (aHR: 1.79, 95% CI: 1.69-1.90, p<0.001) and ages >24 (aHR: 1.11, 95% CI: 1.03-1.20, p=0.005) (Figure 1). In contrast, among pediatric liver recipients, the risk of graft loss during ages 17-24 was no different than during ages <17 (aHR: 1.09, 95% CI: 0.93-1.29, p=0.3) or ages >24 (aHR: 1.17, 95% CI: 0.91-1.50, p=0.2) (Figure 2).

Conclusion. Pediatric liver recipients do not experience an increased risk of graft loss during the high-risk age window seen after pediatric kidney transplantation. The absence of this finding in liver recipients questions the primary role of non-adherence in creating this finding in kidney recipients and suggests that perhaps a biologic mechanism may also have a key role.

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