Factors associated with long‐term graft survival in pediatric kidney transplant recipients

Anand, Adrish; Malik, Tahir; Dunson, Jordan; McDonald, Malcolm; Christmann, Caroline R; Galván, Nhu Thao Nguyen; O’Mahony, Christine A.; Goss, John A.; Srivaths, Poyyapakkam; Brewer, Eileen D.; Rana, Abbas

doi:10.1111/petr.13999

Cited by 16 publications

(17 citation statements)

References 37 publications

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“…Pediatric patients transplanted at an older age will reach that risk period earlier, facing the known development risk for medication nonadherence closer to the time of transplant. [ 17 ] Age as a risk factor for transplant survival has not been well-studied in pediatric populations with liver disease, although our data supports that a younger age at the time of transplant correlates with greater 20-year survival rates. This finding may contradict the common clinical decision to delay transplantation in children for the benefit of allowing a child to live without the burden of transplant and allowing the child to mature physically before such a major procedure; however, further investigation is required prior to such a drastic shift in clinical decision-making.…”

Section: Discussionmentioning

confidence: 55%

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Recipient Age Predicts 20-Year Survival in Pediatric Liver Transplant

Keeling

McDonald

Anand

et al. 2022

Canadian Journal of Gastroenterology and Hepatology

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Introduction Pediatric liver transplant recipients have demonstrated excellent long-term survival. The purpose of this analysis is to investigate factors associated with 20-year survival to identify areas for improvement in patient care. Methods Kaplan–Meier with log-rank test as well as univariate and multivariate logistic regression methods were used to retrospectively analyze 4,312 liver transplant recipients under the age of 18 between September 30, 1987 and March 9, 1998. Our primary endpoint was 20-year survival among one-year survival. Results Logistic regression analysis identified recipient age as a significant risk factor, with recipients below 5 years old having a higher 20-year survival rate ( p < 0.001). A preoperative primary diagnosis of a metabolic dysfunction was found to be protective compared to other diagnoses (OR 1.64, CI 1.20–2.25). African-American ethnicity (OR 0.71, CI 0.58–0.87) was also found to be a risk factor for mortality. Technical variant allografts (neither living donor nor cadaveric) were not associated with increased or decreased rates of 20-year survival. Conclusions Our analysis suggests that long-term survival is inversely correlated with recipient age following pediatric liver transplant. If validated with further studies, this conclusion may have profound implications on the timing of pediatric liver transplantation.

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Section: Discussionmentioning

confidence: 55%

“…[8] In fact, the age of liver donors has been steadily increasing in the United States, with over 33% of donors now being over 50 years of age compared to 1.5% of donors prior to 1985. [8,9,[15][16][17][18].…”

Section: Discussionmentioning

confidence: 99%

Recipient Age Predicts 20-Year Survival in Pediatric Liver Transplant

Keeling

McDonald

Anand

et al. 2022

Canadian Journal of Gastroenterology and Hepatology

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“…Societal bias has led to the unequal distribution of wealth, education, and employment opportunities resulting in a disproportionately high number of African Americans in lower socioeconomic groups 15 . A socioeconomic environment unique to African Americans may limit availability of suitable organs and makes the fulfillment of rigid criteria required for transplant, such as social support and adherence to medical care, more challenging 16 …”

Section: Discussionmentioning

confidence: 99%

“…15 A socioeconomic environment unique to African Americans may limit availability of suitable organs and makes the fulfillment of rigid criteria required for transplant, such as social support and adherence to medical care, more challenging. 16 Center-level and system-level factors such as transplant volume, policies, available capital, and structural center-level practices in addition to health care segregation potentially account for these observed differences. Center-level factors have been found to account graft outcomes disparities in African American patients following kidney transplant.…”

Section: Discussionmentioning

confidence: 99%

Significant improvements, but consistent disparities in survival for African Americans after liver transplantation

Keeling

McDonald

Anand

et al. 2022

Clinical Transplantation

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Despite improvements in survival across races in the past 20 years, African Americans have worse liver transplant outcomes after orthotopic liver transplantation (OLT). This study aims at quantifying the change in disparities between African Americans and other races in survival after OLT. We retrospectively analyzed the United Network for Organ Sharing (UNOS) database for patient data for candidates who received a liver transplant between January 1, 2007 and December 31, 2017. Multivariate Cox proportional hazards regression indicated similar decreases in mortality over time for each race with a decrease in mortality for African Americans: 2010–2012 (HR = .930), 2012–2015 (HR = .882), and 2015–2017 (HR = .883) when compared to 2007–2010. Risk of mortality for African Americans compared to Caucasians varied across the 4 eras: 2007–2010 (HR = 1.083), 2010–2012 (HR = 1.090), 2012–2015 (HR = 1.070), and 2015–2017 (HR = 1.125). While African Americans have seen increases in survival in the past decade, a similar increase in survival for other races leaves a significant survival disparity in African Americans.

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“…Kidney transplantation (KTx) is the most effective treatment for children with end-stage renal disease (ESRD) (1,2). However, long-term outcome of pediatric kidney transplantation is unsatisfactory and the 10-year graft survival rate is only about 60% (3). Antibody-mediated rejection (ABMR) is a crucial factor in poor long-term graft survival in both pediatric and adult kidney transplantation (4,5).…”

Section: Introductionmentioning

confidence: 99%

Dynamics of Donor-Derived Cell-Free DNA at the Early Phase After Pediatric Kidney Transplantation: A Prospective Cohort Study

Nie

Liu

et al. 2022

Front. Med.

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Background: Donor-derived cell-free DNA (ddcfDNA) has been suggested as an indicator of allograft injury in adult and pediatric kidney transplantation (KTx). However, the dynamics of ddcfDNA in pediatric KTx have not been investigated. In addition, it has not been demonstrated whether donor-recipient (D/R) size mismatch affect ddcfDNA level.Methods: Pediatric KTx recipients with a single donor kidney were enrolled and followed up for 1 year. ddcfDNA, calculated as a fraction (%) in the recipient plasma, was examined longitudinally within 3 months post-transplant. D/R size mismatch degree was described as D/R height ratio. The 33rd percentile of D/R height ratio (0.70) was used as the cut-off to divide the patients into low donor-recipient height ratio group (<0.70) and high donor-recipient height ratio group (≥0.70). The dynamics of ddcfDNA were analyzed and the impact factors were explored. Stable ddcfDNA was defined as the first lowest ddcfDNA. ddcfDNA flare-up was defined as a remarkable elevation by a proportion of >30% from stable value with a peak value >1% during elevation.Results: Twenty-one clinically stable recipients were enrolled. The median D/R height ratio was 0.83 (0.62–0.88). It took a median of 8 days for ddcfDNA to drop from day 1 and reach a stable value of 0.67% (0.46–0.73%). Nevertheless, 61.5% patients presented ddcfDNA>1% at day 30. Besides, 81.0% (17/21) of patients experienced elevated ddcfDNA and 47.6% (10/21) met the standard of ddcfDNA flare-up. Donor-recipient height ratio was an independent risk factor for ddcfDNA flare-up (odds ratio = 0.469 per 0.1, 95% CI 0.237–0.925, p = 0.029) and low donor-recipient height ratio (<0.70) was found to increase the risk of flare-up occurrence (odds ratio = 15.00, 95% CI 1.342–167.638, p = 0.028).Conclusions: ddcfDNA rebounds in many stable pediatric KTx recipients without rejection. This may be induced by significant D/R size mismatch and may affect its diagnostic performance at the early phase after pediatric KTx in children.

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Factors associated with long‐term graft survival in pediatric kidney transplant recipients

Cited by 16 publications

References 37 publications

Recipient Age Predicts 20-Year Survival in Pediatric Liver Transplant

Recipient Age Predicts 20-Year Survival in Pediatric Liver Transplant

Significant improvements, but consistent disparities in survival for African Americans after liver transplantation

Dynamics of Donor-Derived Cell-Free DNA at the Early Phase After Pediatric Kidney Transplantation: A Prospective Cohort Study

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