National Trends Over 25 Years in Pediatric Kidney Transplant Outcomes

Abstract

WHAT'S KNOWN ON THIS SUBJECT: Kidney transplantation is the optimal treatment of children with end-stage renal disease. The field of pediatric kidney transplantation has changed over time with regard to immunosuppression, surgical technique, organ allocation policy, and rates of living donor transplantation. WHAT THIS STUDY ADDS:Outcomes after pediatric kidney transplantation in the United States have improved over time, independent of changes in recipient, donor, and transplant characteristics. These improvements were most dramatic within the first posttransplant year and among the most highly sensitized patients. abstract OBJECTIVE: To investigate changes in pediatric kidney transplant outcomes over time and potential variations in these changes between the early and late posttransplant periods and across subgroups based on recipient, donor, and transplant characteristics. METHODS:Using multiple logistic regression and multivariable Cox models, graft and patient outcomes were analyzed in 17 446 pediatric kidneyonly transplants performed in the United States between 1987 and 2012.RESULTS: Ten-year patient and graft survival rates were 90.5% and 60.2%, respectively, after transplantation in 2001, compared with 77.6% and 46.8% after transplantation in 1987. Primary nonfunction and delayed graft function occurred in 3.3% and 5.3%, respectively, of transplants performed in 2011, compared with 15.4% and 19.7% of those performed in 1987. Adjusted for recipient, donor, and transplant characteristics, these improvements corresponded to a 5% decreased hazard of graft loss, 5% decreased hazard of death, 10% decreased odds of primary nonfunction, and 5% decreased odds of delayed graft function with each more recent year of transplantation. Graft survival improvements were lower in adolescent and female recipients, those receiving pretransplant dialysis, and those with focal segmental glomerulosclerosis. Patient survival improvements were higher in those with elevated peak panel reactive antibody. Both patient and graft survival improvements were most pronounced in the first posttransplant year. CONCLUSIONS:Outcomes after pediatric kidney transplantation have improved dramatically over time for all recipient subgroups, especially for highly sensitized recipients. Most improvement in graft and patient survival has come in the first year after transplantation, highlighting the need for continued progress in long-term outcomes. The field of pediatric KT has evolved over the past 25 years, including changes in immunosuppression, surgical technique, organ allocation policy, and rates of living donor transplantation. 4 However, the relationship between these changes and post-KT outcomes remains unclear, both in terms of which patient phenotypes have been affected and when any changes in outcomes have occurred (ie, early versus late post-KT).The objective of this study was to examine changes in pediatric KToutcomes over the last 25 years. In particular, our work sought to assess trends in graft survival, rates of primary nonfunct...

Favourable outcomes for the first 10 years of kidney and pancreas transplantation at Wits Donald Gordon Medical Centre, Johannesburg, South Africa

“…[14] In a recent publication from the USA that reviewed 17 000 paediatric kidney transplants, outcomes were significantly better after 2001, which may be related to better immunosuppression, with 10-year recipient and graft survival rates of 90.5% and 60.2%, respectively. [15] Explanations for the relatively good survival in our cohort, given that it is still a small sample, may reflect the more 'recent' time frame of analysis; higher living donor rates (64%) compared with 24% at RCWMCH and 21% at CMJAH; fewer black children, who have been shown to have poorer graft survival; fewer repeat transplants; and the assumption that socioeconomic circumstances are better in patients accessing a funded healthcare environment. [16] SKP transplantation is considered the treatment of choice for type 1 diabetics with end-stage kidney disease who are <50 years of age.…”

Outcome of Patients Initiating Chronic Peritoneal Dialysis During the First Year of Life

“…After this transition from maintenance dialysis to renal transplantation, graft survival among the recently transplanted infants was better than that of infants in the past cohort and is consistent with the results of recent single-center reports and those published by the Scientific Registry of Transplant Recipients. [6][7][8]27 Because graft survival has consistently improved among all pediatric age groups over the past few decades as a result of a variety of factors, including improved immunosuppression and surgical technique and a better understanding of transplant-related immunology, 28 there is every reason to expect that transplant outcomes will continue to improve overall and among the youngest patients.…”

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“…Our observed patient survival is consistent with the outcomes described in the literature. 2,3 Further research is needed on this topic, and large-scale studies are indicated. …”