Outcomes of Pediatric Kidney Transplantation in Recipients of a Previous Non-Renal Solid Organ Transplant

Abstract

Children who receive a non-renal solid organ transplant may develop secondary renal failure requiring kidney transplantation. We investigated outcomes of 165 pediatric kidney transplant recipients who previously received a heart, lung, or liver transplant using data from 1988 to 2012 reported to the United Network for Organ Sharing. Patient and allograft survival were compared with 330 matched primary kidney transplant (PKT) recipients. Kidney transplantation after solid organ transplant (KASOT) recipients experienced similar allograft survival: 5- and 10-year graft survival was 78% and 60% in KASOT recipients, compared to 80% and 61% in PKT recipients (p = 0.69). However, KASOT recipients demonstrated worse 10-year patient survival (75% KASOT vs. 97% PKT, p < 0.001). Competing risks analysis indicated that KASOT recipients more often experienced graft loss due to patient death (p < 0.001), whereas allograft failure per se was more common in PKT recipients (p = 0.01). To study more recent outcomes, kidney transplants performed from 2006 to 2012 were separately investigated. Since 2006, KASOT and PKT recipients had similar 5-year graft survival (82% KASOT vs. 83% PKT, p = 0.48), although 5-year patient survival of KASOT recipients remained inferior (90% KASOT vs. 98% PKT, p < 0.001). We conclude that despite decreased patient survival, kidney allograft outcomes in pediatric KASOT recipients are comparable to those of PKT recipients.

Sequential transplantation and implications for clinical management: OLT followed by HCT and consequent RT in a pediatric patient

“…The adult population has been using RT following NRSOT for some time, with the pediatric population more recently starting to report successful cases of tandem transplants . Evidence thus far has demonstrated good outcomes—Hamdani et al demonstrated good graft survival data in patients receiving RT following SOT compared to primary RT. Despite increased mortality in patients requiring tandem transplants, graft survival was not statistically significant between primary RT recipients and those who received RT after SOT.…”

“…Overall patient survival was slightly worse in patients who had received prior SOT: 88% survival at 5 years and 75% at 10 years, compared to 97% at 5 and 10 years, respectively, for primary RT. This is theorized to be due to increased morbidity and mortality of receiving a prior SOT …”

“…This is theorized to be due to increased morbidity and mortality of receiving a prior SOT. 13 There has been increasing literature in adult transplantation, particularly in the SOT population to support successful transition to CNI-sparing regimens, either transitioning to MMF with or without steroids, or reducing targeted goals of CNI agents. Pediatric liver transplant studies have demonstrated stabilization or reversal of decreased GFR with addition of MMF with or without steroids, as well as the ability to significantly decrease or withdraw CNI therapy completely.…”

“…ESRD in the posttransplantation period increases the risk of death more than threefold, with this risk increasing to ninefold in subjects on dialysis . Despite increased mortality in patients requiring tandem transplants, both overall patient survival and graft survival have demonstrated favorable outcomes . There have been sparse case reports of patient survival in RT following HCT, as well as reports of survival and maintenance of solid organ graft function throughout RT following SOT …”

“…12 Despite increased mortality in patients requiring tandem transplants, both overall patient survival and graft survival have demonstrated favorable outcomes. 13 There have been sparse case reports of patient survival in RT following HCT, 14 as well as reports of survival and maintenance of solid organ graft function throughout RT following SOT. 15 As the life expectancy of pediatric and adult patients after transplantation is increasing, investigations have shifted to examine late complications.…”