Post‐transplant complications, patient, and graft survival in pediatric and adolescent kidney transplant recipients at a tropical tertiary care center across two immunosuppression eras

Abstract

Background We report pediatric PAKT patient and graft outcomes at a large tropical tertiary center spanning two transplant eras. Methods In this retrospective cohort study, all children ≤18 years who underwent kidney transplantation at our center between 1991 and 2016 were included. Data pertaining to their baseline characteristics, post‐transplant events, and outcome were retrieved from transplant records and compared between transplant eras (1991‐2005 and 2006‐2016). Results A total of 139 children (mean age 15.2 ± 2.9 years) underwent PAKT during this period. The incidence of UTIs, CMV disease, BKVN, invasive fungal infections, new‐onset diabetes after transplant, leucopenia, and recurrent NKD was higher in the 2006‐2016 era (P < .001 for all), while 1‐year cumulative BPAR was comparable (P = .100). Five‐year graft and patient survival in the two eras were 89.9% and 94.2% (P = .365) and 92.1% and 95.3% (P = .739), respectively. Incidence of CMV disease, BKVN, graft loss, and death was lower in the calcineurin withdrawal group. Non‐adherence accounted for 36% of graft loss; infections caused 43.7% of deaths. On multivariate Cox proportional hazards analysis, independent predictors for graft loss were UTIs and blood transfusion naïve status and for death were serious infections and glomerular NKD. Conclusions PAKT in India has excellent long‐term graft outcomes, though patient outcomes remain suboptimal owing to a high burden of infections. Current immunosuppression protocols need to be re‐examined to balance infection risk, graft, and patient survival.

Outcomes of pediatric deceased donor kidney transplant in northeast Thailand

“…In this study, the majority of KT recipients were male, and the most common etiology of ESRD was congenital anomalies of the kidneys and urinary tract, both of which are consistent with previously published reports 3–10 . However, there were no patients with ESRD caused by obstructive uropathy, which is more common in boys.…”

“…3,10 Although several agents have recently emerged for renal rejection therapy, drug availability, expense, and efficacy limit their usage. The rates of early graft and patient survival in this study were comparable to those in previous reports; 3,4,7,8 however, long-term outcomes, especially after the patient is transferred to the adult unit, require further examination.…”

“…Factors associated with graft failure in previously published reports include DGF, 4 donor GFR <30 ml/min/1.73 m 2 , 4 high numbers of HLA mismatches, 16 older donor age, 6 older recipient age, 6 BK viremia, 6 and urinary tract infection 7 . In the present study, DGF was the only significant risk factor for graft failure, likely due to the small sample size and retrospective design.…”

“…Bacterial urinary tract infection is the most frequent infectious post‐KT complication worldwide 3,6,7,13–15 . CMV infection was lower in the present study despite the small number of patients who received CMV prophylaxis.…”

“…Factors associated with graft failure in previously published reports include DGF, 4 donor GFR <30 ml/min/1.73 m 2 , 4 high numbers of HLA mismatches, 16 older donor age, 6 older recipient age, 6 BK viremia, 6 and urinary tract infection. 7 In the present study, DGF was the only significant risk factor for graft failure, likely due to the small sample size and retrospective design. However, modifiable DGF risk factors, including vascular instability of the deceased donor, long CIT, static cold storage of the graft, reperfusion injury, size disproportion between donor and recipient vessels, surgical complications, and non-optimal fluid therapy post-KT, should be prevented to decrease ischemia-reperfusion injury and improve graft survival.…”