PREDICTORS OF GRAFT SURVIVAL IN PEDIATRIC LIVING-RELATED KIDNEY TRANSPLANT RECIPIENTS1

TLDR

Kidney transplantation from a living‑related donor is the most effective renal replacement therapy for children, offering reduced dialysis time and superior graft survival and function compared with cadaveric kidneys. The authors retrospectively analyzed UNOS registry data on 2,418 children aged 0–18 who received living‑related donor kidneys between 1988 and 1994 to identify risk factors for graft loss. They performed multivariate survival analysis using Kaplan‑Meier and Cox regression models to assess the impact of age, pretransplant dialysis, early rejection, and race on graft outcomes. The analysis revealed that age at transplant, pretransplant dialysis, early rejection, and race significantly affect graft survival, with infants under 2 years initially faring poorly but improving to 71% at 7 years, adolescents showing the best early survival that declines to 55% over time, and African‑American recipients having the highest relative risk of graft loss, while gender, peak PRA, and ABO type were not significant predictors.

Abstract

A successful kidney transplant from a living-related donor (LRD) remains the most effective renal replacement therapy for children with end-stage renal failure. The use of LRD kidneys results in decreased time on dialysis, increased graft survival, and better function compared with kidneys transplanted from cadaver donors. We retrospectively analyzed data from the United Network of Organ Sharing (UNOS) Scientific Renal Transplant Registry to determine risk factors for graft loss in children who received an LRD kidney.Data was obtained from the UNOS Scientific Renal Transplant Registry on 2418 children ranging in age from 0 to 18 years who underwent an LRD kidney transplantation between January 1988 and December 1994. Multivariate analysis of graft survival was performed using Kaplan-Meier and Cox regression models.The effects of age, pretransplantation dialysis, early rejection, and race were found to significantly affect graft survival. Gender, peak panel-reactive antibody, and ABO blood type were not found to be significant risk factors. Infants <2 years of age initially had the worst graft survival; however, over time their results stabilized, and at 7 years estimated graft survival was good (71%). Adolescents ranging in age from 13-18 years had the best initial graft survival, but as time went on graft survival worsened (55%). Patients who underwent pretransplantation dialysis had a relative risk for graft loss of 1.77 (P<0.001), whereas those who had an early rejection had a relative risk for graft loss of 1.41 (P<0.002). African-Americans had a significantly higher relative risk for graft loss than either Caucasians (1.57, P<0.0005) or Hispanics (2.01, P<0.0003).Predictors of graft survival for children who receive LRD kidney transplants include age at transplantation, pretransplantation dialysis, early rejection, and race. Over time, adolescents and African-Americans seem to have the lowest graft survival.