Purpose: We aimed to study the renal outcomes of pediatric kidney transplant recipients following a previous non-renal solid organ transplantation (SOT).

Methods: A retrospective analysis of the United Network for Organ Sharing database was performed to identify pediatric kidney transplant recipients who had a previous SOT (PSOT) in the years 1988-2012. Renal outcomes of kidney transplant recipients with a PSOT, including acute rejection at 6 months, graft survival, and death censored graft survival, were compared with matched cohort of pediatric primary kidney (PKT) transplant recipients. Subjects were matched by age, race, gender, donor type, transplantation year, HLA matching, and tacrolimus-based immunosuppression.

Results: 221 PSOT recipients (mean age 13.8 years) were identified and compared with 300 matched PKT patients. Previous solid organ transplant included a liver in 53% and a heart/lung in 47% of the cohort. There was a trend among PSOT recipients to have decreased acute rejection at 6 months (11 % vs. 18% in PSOT and PKT groups, respectively), although this did not reach significance (p = 0.08). PSOT recipients had improved 5-year death censored graft survival (85% vs. 78%, p = 0.01), although overall 5-year graft survival (including patient death) was similar (73% vs 76%, p =0.86). To further investigate outcomes during the study period, the cohort was divided into patients receiving a kidney transplant before 2006 and since 2006. Among patients who received a kidney transplantation before 2006, both acute rejection rate at 6 months (13% vs. 26%, p=0.03) and five year death censored graft survival (83% vs 76%, p=0.02) were improved among the PSOT group. In patients who received a kidney since 2006, rejection rates at 6 months were much lower (9% in both groups), and there was no significant difference in five year death-censored graft survival (83% vs 85%).

Conclusion: Prior to 2006, kidney transplantation following a PSOT was associated with improved death-censored graft survival and decreased acute rejection. However, since 2006 kidney transplants recipients with a PSOT have similar outcomes to children receiving a primary kidney transplant, perhaps related to overall improved graft outcomes in later years.

CITATION INFORMATION: Hamdani G, Zhang B, Goebel J, Nehus E. Renal Outcomes of Pediatric Kidney Transplant Recipients Following a Previous Solid Organ Transplantation. Am J Transplant. 2016;16 (suppl 3).

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