Long‐term mortality in pediatric solid organ recipients—A nationwide study

Abstract

Background: The present study aimed at investigating long-term mortality of patients who underwent solid organ transplantation during childhood and at identifying their causes of death. Methods:A cohort of 233 pediatric solid organ transplant recipients who had a kidney, liver, or heart transplantation between 1982 and 2015 in Finland were studied.Year of birth-, sex-, and hometown-matched controls (n = 1157) were identified using the Population Register Center registry. The Causes of Death Registry was utilized to identify the causes of death.Results: Among the transplant recipients, there were 60 (25.8%) deaths (median follow-up 18.0 years, interquartile range of 11.0-23.0 years). Transplant recipients' risk of death was nearly 130-fold higher than that of the controls (95% CI 51.9-1784.6).The 20-year survival rates for kidney, liver, and heart recipients were 86.1% (95% CI 79.9%-92.3%), 58.5% (95% CI 46.2%-74.1%), and 61.4% (95% CI 48.1%-78.4%), respectively. The most common causes of death were cardiovascular diseases (23%), infections (22%), and malignancies (17%). There were no significant differences in survival based on sex or transplantation era. Conclusion:The late mortality is still significantly higher among pediatric solid organ recipients in comparison with controls. Cardiovascular complications, infections, and cancers are the main causes of late mortality for all studied transplant groups. These findings emphasize the cruciality of careful monitoring of pediatric transplant recipients in order to reduce long-term mortality.

mTor‐inhibition within the first days after pediatric heart transplantation is a potentially safe option to prevent cardiac allograft vasculopathy

“…Only one patient with failing Fontan circulation with protein losing enteropathy died because of sepsis after HTX, which might not necessarily be related to the kind of immunosuppression. Although it is this early post‐HTX phase that has witnessed the greatest improvements in survival in recent years, there is still strong evidence that the risk of death is highest during the early phase after HTX 15–17 . In our population, four of the seven deaths occurred during the first 100 days after HTX.…”

“…Although it is this early post-HTX phase that has witnessed the greatest improvements in survival in recent years, there is still strong evidence that the risk of death is highest during the early phase after HTX. [15][16][17] In our population, four of the seven deaths occurred during the first 100 days after HTX. According to the SRTR Report, the leading causes of death among organ recipients between 2016 and 2017 in the first year after HTX were infections (1.4%) and cardiac/cerebrovascular disease (1.4%).…”

The ongoing need to improve long‐term patient survival of pediatric solid organ recipients

“…Salonen et al 6 reported survival of all pediatric SOT recipients (kidney, liver and heart) in Finland. Apart from being a nationwide study, the inclusion of year of birth, sex and hometown‐matched control group forms a considerable strength.…”

“…However, we need data on longer‐term outcomes, preferably country‐wide or from larger jurisdictions, to develop strategies for improved patient survival. In this context, we are delighted to see the manuscript by Rebekka Salonen et al reporting long‐term mortality in Finland from 1982 to 2015 6 …”

HLA (emphasis on DQ) compatibility for longer allograft survival in pediatric transplantation: Modern evidence and challenges

“…1 Critically for pediatric patients, beyond the improved quality of life 2,3 there is also significant improvement in physical 4,5 and cognitive development. 6 Unfortunately, long-term graft and patient survival rates are still suboptimal, [7][8][9] and the lifelong requirement for immunosuppression in children is associated with complications and mortality. 10 Immunosuppression minimization and non-adherence, that is especially prevalent among pediatric patients, 11 can lead to increased risk of generating de-novo donor-specific HLA antibodies (dnDSA) and inferior graft outcomes.…”