Metabolic risk factors and long-term graft function after paediatric renal transplantation

Abstract

SummaryThe aim of this study was to evaluate metabolic risk factors and their impact on long-term allograft function in paediatric renal transplant (RTx) patients. We reviewed the medical records of 210 RTx patients who underwent transplantation at a median age of 4.5 years (range 0.7-18.2) and a median follow-up of 7.0 years (range 1.5-18.0). Data on lipid and glucose metabolism, uric acid levels, weight and blood pressure were collected up to 13 years post-RTx, and the findings were correlated with the measured glomerular filtration rate (GFR). Beyond the first year, GFR showed gradual deterioration with a mean decline of 2.4 ml/min/ 1.73 m 2 /year. Metabolic syndrome, overweight, hypertension and type 2 diabetes were diagnosed in 14-19%, 20-23%, 62-87% and 3-5% of the patients, respectively. These entities showed only mild association with the concomitant or long-term GFR values. Dyslipidaemia was common and hypertriglyceridaemia associated with a lower GFR at 1.5 and 5 years post-RTx (P = 0.008 and P = 0.017, respectively). Similarly, hyperuricaemia was frequent and associated significantly with GFR (P < 0.001). Except for hyperuricaemia and hypertriglyceridaemia, metabolic risk factors beyond the first postoperative year associated modestly with the long-term kidney graft function in paediatric RTx patients.

Uric acid increases cellular and humoral alloimmunity in primary human peripheral blood mononuclear cells

“…Many studies have linked hyperuricaemia with a worse kidney allograft outcome, and indicated a possible benefit from treating asymptomatic hyperuricaemia . Episodes of acute cellular rejection and chronic antibody‐mediated rejection decrease graft survival .…”

Renal transplantation in infants

“…The data on metabolic risk factors among pediatric RTx patients are still limited. In a cohort of patients mostly transplanted before the age of 2 years, metabolic syndrome, overweight, hypertension, and type 2 diabetes were observed in 14-19 %, 20-23 %, 61-87 %, and 3-5 % of patients at 1.5-5 years after RTx, respectively [45]. Higher incidences of these risk factors, however, have been reported in pediatric RTx patients [80][81][82][83].…”

“…1 In infants, the kidney graft can be placed intraperitoneally (a) or extraperitoneally (b) [44]. The other possibility is to switch to low-dose (0.1 mg/kg/ day), every-other-day medication, which also effectively abolishes the steroid side effects [45,46].…”

Renal function after combined liver‐kidney transplantation: A longitudinal study of pediatric and adult patients

“…The prevalence of CKD was 25% up to six months after CLKT in small study . We have previously shown that GFR remains relatively stable from one up to five years after adult and pediatric LT and also after pediatric KT . Others have reported that GFR remains steady or slightly worsens up to five years after adult and pediatric CLKT .…”