Acute rejection in pediatric renal transplantation: Retrospective study of epidemiology, risk factors, and impact on renal function

Abstract

AR is a major relevant and challenging topic in pediatric kidney transplantation. Our objective was to evaluate cumulative incidence of AR in pediatric kidney transplant patient, risk factors for this outcome, and impact on allograft function and survival. A retrospective cohort including pediatric patients that underwent kidney transplantation between 2011 and 2015 was designed. Risk factors for AR were tested by competing risk analysis. To estimate its impact, graft survival and difference in GFR were evaluated. Two hundred thirty patients were included. As a whole, the incidence of AR episodes was 0.16 (95% CI = 0.12‐0.20) per person‐year of follow‐up. And cumulative incidence of AR was 23% in 1 year and 39% in 5 years. Risk factors for AR were number of MM (SHR 1.36 CI 1.14‐1.63 P = .001); ISS with CSA, PRED, and AZA (SHR 2.22 CI 1.14‐4.33 P = .018); DGF (SHR 2.49 CI 1.57‐3.93 P < .001); CMV infection (SHR 5.52 CI 2.27‐11.0 P < .001); and poor adherence (SHR 2.28 CI 1.70‐4.66 P < .001). Death‐censored graft survival in 1 and 5 years was 92.5% and 72.1%. Risk factors for graft loss were number of MM (HR 1.51 CI 1.07‐2.13 P = .01), >12 years (HR 2.66 CI 1.07‐6.59 P = .03), and PRA 1%‐50% (HR 2.67 CI 1.24‐5.73 P = .01). Although occurrence of AR did not influence 5‐year graft survival, it negatively impacted GFR. AR was frequent in patients assessed and associated with number of MM, ISS regimen, DGF, CMV infection, and poor adherence, and had deleterious effect on GFR.

Clinical characteristics and complications of kidney transplantation among an Egyptian pediatric cohort

“…AR can occur at any time post-transplant, but the peak occurs in first year post transplant. According to the onset of AR, it can be classified as early (in 1st 3-months), delayed (between 3 months and 1year) and late (after 1year) in 25%, 41.7% and 33.3 % respectively as done in another study (31). Human leukocyte antigen (HLA) mismatch was 3/6 in 61.…”

Growth hormone treatment in the pre-transplant period is associated with superior outcome after pediatric kidney transplantation

“…C-reactive protein is a marker of the acute phase response to inflammation. Elevated circulating CRP (> 3 mg/L) is associated with accelerated deterioration of graft function in kidney transplant recipients and thought to reflect kidney inflammation due to subclinical rejection [37][38][39][40][41]. Therefore, the notion of significantly elevated CRP levels in the non-prior rhGH group may not only explain the higher frequency of anemia as a consequence of inflammation but also subclinical graft rejection in these patients which may contribute to the inferior long-term graft function.…”