Trajectories and Predictors of Allograft Dysfunction after Renal Transplantation in Children

Souza, V. de; Rabilloud, Muriel; Cochat, Pierre; Wagner, Mário Bernardes; Garcia, Clotilde Druck; Ranchin, Bruno; Iwaz, Jean; Selistre, Luciano; Dubourg, Laurence

doi:10.1159/000453076

Cited by 5 publications

(5 citation statements)

References 24 publications

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“…When we consider the burden of therapy required to maintain allograft function, the traditional approach of surgically treating only high‐grade transplant VUR with associated febrile UTI is supported by our finding that eGFR outcomes are similar in the hydronephrosis, febrile UTI, and abnormal renal biopsy groups. While the population in this study is small, the overall eGFR for the combined group is consistent with graft function based on historical controls . As shown by Weigel et al, there are multiple factors that affect graft function, and it is difficult to show that management of VUR alone will impact eGFR.…”

Section: Discussionmentioning

confidence: 47%

When does vesicoureteral reflux in pediatric kidney transplant patients need treatment?

Concepcion

Grimm

2018

Pediatric Transplantation

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Purpose The treatment of VUR in children with UTI has changed significantly, due to studies showing that antibiotic prophylaxis does not decrease renal scarring. As children with kidney transplants are at higher risk for UTI, we investigated if select patients with renal transplant VUR could be managed without surgery. Materials and Methods A total of 18 patients with VUR into their renal grafts were identified, and 319 patients underwent transplantation from 2006 to 2016. The cause for the detection of the VUR, treatment, and graft function was reviewed. Results Six boys and 12 girls were identified, 13 of whom had grade 3 or 4 VUR into the renal graft. Nine patients presented with hydronephrosis or abnormal renal biopsy: eight were successfully managed with antibiotic prophylaxis and bladder training, one developed UTI and underwent Dx/HA subureteric injection. Nine patients presented with recurrent febrile UTI, only one was successfully managed without surgery. Only 2 of 9 (22%) patients who underwent Dx/HA injection had resolution of their reflux. Of the remaining seven, five required open ureteral reimplantation (two for obstruction), one lost the graft due to rejection, and one had significant hydronephrosis. eGFR was similar between the hydronephrosis, UTI, and abnormal renal biopsy groups at all times. Conclusion Patients with transplant VUR and recurrent febrile UTI are more likely to require surgical therapy, but the complication and failure rate for Dx/HA injection is significant. Patients with transplant VUR without febrile UTI can be successfully managed with bladder training and temporary antibiotic prophylaxis.

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Section: Discussionmentioning

confidence: 47%

When does vesicoureteral reflux in pediatric kidney transplant patients need treatment?

Concepcion

Grimm

2018

Pediatric Transplantation

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“…In another study on 67 pediatric kidney transplant recipients 10 an important risk factor for kidney failure in patients with CKD 24 and patients after kidney transplantation. 25 A multi-phasic eGFR trajectory with initial stability and subsequent decline can be expected in these events .…”

Section: Discussionmentioning

confidence: 99%

“…Episodes of rapid progression were more common in patients whose grafts subsequently failed, but nonlinearity was not associated with graft failure, probably due to the small number of patients in the cohort. In another study on 67 pediatric kidney transplant recipients 10 who underwent 278 inulin‐clearance measurements over a 10 year period, three trajectories of kidney allograft function, have been identified. The researchers have found that the “low and decreasing” trajectory pattern was more prevalent in recipients from deceased and older donors.…”

Section: Discussionmentioning

confidence: 99%

“…patients with eGFRs below 41 mL/min/1.73 m2 were more likely to show nonlinearity and periods of rapid progression. In another small study on a pediatric population 10 having a living donor increased the probability of decreasing trajectory which had a poor outcome. Raynaud, 11 in a large‐scale study that included 14 132 patients eight trajectory patterns that were highly associated with clinical and histological predictors as well as graft outcome were found, by using latent class mixed model.…”

Section: Introductionmentioning

confidence: 94%

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Multi‐phasic eGFR trajectory during follow up and long‐term graft failure after kidney transplantation

Rahamimov,

Agur,

Zingerman

et al. 2023

Clinical Transplantation

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BackgroundThe prevailing assumption is that following kidney transplantation the pattern of kidney function decline is consistent. Nevertheless, numerous factors leading to graft loss may emerge, altering the trajectory of kidney function. In this study, we aim to assess alterations in estimated glomerular filtration rate (eGFR) trajectory over an extended period of follow‐up and examine its correlation with graft survival.MethodsWe calculated eGFR using all creatinine values available from 1‐year post transplantation to the end of follow‐up. For pattern analysis, we used a piecewise linear model.ResultsNine hundred eighty‐eight patients were included in the study. After a median follow‐up of 5.2 years, 297 (30.1%) patients had a multi‐phasic eGFR trajectory. Change in eGFR trajectory was associated with increased risk for graft failure (HR 7.15, 95% CI 5.17–9.89, p < .001), longer follow‐up time, younger age, longer cold ischemia time, high prevalence of acute rejection, longer hospitalization and a lower initial eGFR. Of the 988 patients included in the study, 494 (50.0%) had a mono‐phasic stable trajectory, 197 (19.9%) had a mono‐phasic decreasing trajectory, 184 (18.6%) had bi‐phasic decreasing trajectory (initial stability and then decline, 46(4.7%) had a bi‐phasic stabilized (initial decline and then stabilization) and 67(6.8%) had a more complex trajectory (tri‐phasic). Out of the total 144 patients who experienced graft loss, the predominant pattern was a bi‐phasic decline characterized by a bi‐linear trajectory (66 events, 45.8%).ConclusionsChanges in eGFR trajectory during long‐term follow‐up can serve as a valuable tool for assessing the underlying mechanisms contributing to graft loss.

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“…Although there has been an increased interest in examining renal function trajectories in CKD [13,14], there is little work in kidney transplantation [15]. Work from CKD groups and our own in renal transplant recipients [16] suggest that most patients do not experience linear renal function.…”

Section: Introductionmentioning

confidence: 99%

Early renal function trajectories, cytomegalovirus serostatus and long-term graft outcomes in kidney transplant recipients

et al. 2021

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Background Improved recognition of factors influencing graft survival has led to better short-term kidney transplant outcomes. However, efforts to prevent long-term graft decline and improve graft survival have seen more modest improvements. The adoption of electronic health records has enabled better recording and identification of donor-recipient factors through the use of modern statistical techniques. We have previously shown in a prevalent renal transplant population that episodes of rapid deterioration are associated with graft loss. Methods Estimated glomerular filtration rates (eGFR) between 3 and 27 months after transplantation were collected from 310 kidney transplant recipients. We utilised a Bayesian approach to estimate the most likely eGFR trajectory as a smooth curve from an average of 10,000 Monte Carlo samples. The probability of having an episode of rapid deterioration (decline greater than 5 ml/min/1.73 m2 per year in any 1-month period) was calculated. Graft loss and mortality data was collected over a median follow-up period of 8 years. Factors associated with having an episode of rapid deterioration and associations with long-term graft loss were explored. Results In multivariable Cox Proportional Hazard analysis, a probability greater than 0.8 of rapid deterioration was associated with long-term death-censored graft loss (Hazard ratio 2.17; 95% Confidence intervals [CI] 1.04–4.55). In separate multivariable logistic regression models, cytomegalovirus (CMV) serostatus donor positive to recipient positive (Odds ratio [OR] 3.82; 95%CI 1.63–8.97), CMV donor positive (OR 2.06; 95%CI 1.15–3.68), and CMV recipient positive (OR 2.03; 95%CI 1.14–3.60) were associated with having a greater than 0.8 probability of an episode of rapid deterioration. Conclusions Early episodes of rapid deterioration are associated with long-term death-censored graft loss and are associated with cytomegalovirus seropositivity. Further study is required to better manage these potentially modifiable risks factors and improve long-term graft survival.

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Trajectories and Predictors of Allograft Dysfunction after Renal Transplantation in Children

Cited by 5 publications

References 24 publications

When does vesicoureteral reflux in pediatric kidney transplant patients need treatment?

When does vesicoureteral reflux in pediatric kidney transplant patients need treatment?

Multi‐phasic eGFR trajectory during follow up and long‐term graft failure after kidney transplantation

Early renal function trajectories, cytomegalovirus serostatus and long-term graft outcomes in kidney transplant recipients

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