Outcomes and Risk Factors for Graft Loss: Lessons Learned from 1,056 Pediatric Kidney Transplants at the University of Minnesota

Srinath Chinnakotla, Priya Verghese, Blanche Chavers, Michelle N. Rheault, Varvara Kirchner, Ty Dunn, Clifford Kashtan, Thomas Nevins, Michael Mauer, Timothy Pruett, Youngki Kim, Lydia Najera, Christian Hanna, Sarah Kizilbash, Marie Cook, Lars J. Cisek, Kristen Gillingham, Yi Yang, Arthur Matas, John Najarian

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Abstract

Background Advances in immunosuppression, surgical techniques, and management of infections in children receiving kidney transplants have affected outcomes. Study Design We analyzed a prospectively maintained database of pediatric kidney transplantations. Results From June 1963 through October 2016, we performed 1,056 pediatric kidney transplantations. Of these, 129 were in children less than 2 years old. The most common indications for transplant were congenital anomalies (dysplastic kidneys), obstructive uropathy, and congenital nephrotic syndrome. Living donors constituted 721 (68%) of all donors. The graft and patient survival rates remarkably improved for both deceased and living donor recipients (p = 0.001). Currently, graft survival rates for deceased donor recipients are 92% at 1 year, 76% at 5 years, and 57% at 10 years post-transplant; for living donor recipients, 96% at 1 year, 85% at 5 years, and 78% at 10 years. The graft half-life was 19 years in deceased donor recipients, compared with 25 years in living donor recipients (p ≤ 0.001). Acute rejection was the most common cause of graft loss in the first year post-transplant. The following risk factors were associated with an increased risk of graft loss: deceased donor grafts (p = 0.0001), retransplant (p = 0.02), ages 11 to 18 years (p = 0.001) and pre-transplant urologic issues (p = 0.04). Living donor grafts (p ≤ 0.0001) and pre-emptive transplants (p = 0.02) were associated with decreased risks of graft loss. Conclusions The success rates of pediatric kidney transplants have significantly improved. Pre-emptive kidney transplantation with a living donor graft continues to be superior and should be the choice in children with end-stage renal disease.

Original languageEnglish (US)
Pages (from-to)473-486
Number of pages14
JournalJournal of the American College of Surgeons
Volume224
Issue number4
DOIs
StatePublished - Apr 1 2017

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Pediatrics
Transplants
Kidney
Living Donors
Tissue Donors
Kidney Transplantation
Graft Survival
Survival Rate
Nephrotic Syndrome
Immunosuppression
Chronic Kidney Failure
Half-Life
Databases
Infection

Cite this

@article{30fd433c6fbe41319f4d8e22f016e478,
title = "Outcomes and Risk Factors for Graft Loss: Lessons Learned from 1,056 Pediatric Kidney Transplants at the University of Minnesota",
abstract = "Background Advances in immunosuppression, surgical techniques, and management of infections in children receiving kidney transplants have affected outcomes. Study Design We analyzed a prospectively maintained database of pediatric kidney transplantations. Results From June 1963 through October 2016, we performed 1,056 pediatric kidney transplantations. Of these, 129 were in children less than 2 years old. The most common indications for transplant were congenital anomalies (dysplastic kidneys), obstructive uropathy, and congenital nephrotic syndrome. Living donors constituted 721 (68{\%}) of all donors. The graft and patient survival rates remarkably improved for both deceased and living donor recipients (p = 0.001). Currently, graft survival rates for deceased donor recipients are 92{\%} at 1 year, 76{\%} at 5 years, and 57{\%} at 10 years post-transplant; for living donor recipients, 96{\%} at 1 year, 85{\%} at 5 years, and 78{\%} at 10 years. The graft half-life was 19 years in deceased donor recipients, compared with 25 years in living donor recipients (p ≤ 0.001). Acute rejection was the most common cause of graft loss in the first year post-transplant. The following risk factors were associated with an increased risk of graft loss: deceased donor grafts (p = 0.0001), retransplant (p = 0.02), ages 11 to 18 years (p = 0.001) and pre-transplant urologic issues (p = 0.04). Living donor grafts (p ≤ 0.0001) and pre-emptive transplants (p = 0.02) were associated with decreased risks of graft loss. Conclusions The success rates of pediatric kidney transplants have significantly improved. Pre-emptive kidney transplantation with a living donor graft continues to be superior and should be the choice in children with end-stage renal disease.",
author = "Srinath Chinnakotla and Priya Verghese and Blanche Chavers and Rheault, {Michelle N.} and Varvara Kirchner and Ty Dunn and Clifford Kashtan and Thomas Nevins and Michael Mauer and Timothy Pruett and Youngki Kim and Lydia Najera and Christian Hanna and Sarah Kizilbash and Marie Cook and Cisek, {Lars J.} and Kristen Gillingham and Yi Yang and Arthur Matas and John Najarian",
year = "2017",
month = "4",
day = "1",
doi = "10.1016/j.jamcollsurg.2016.12.027",
language = "English (US)",
volume = "224",
pages = "473--486",
journal = "Journal of the American College of Surgeons",
issn = "1072-7515",
publisher = "Elsevier Inc.",
number = "4",

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TY - JOUR

T1 - Outcomes and Risk Factors for Graft Loss

T2 - Lessons Learned from 1,056 Pediatric Kidney Transplants at the University of Minnesota

AU - Chinnakotla, Srinath

AU - Verghese, Priya

AU - Chavers, Blanche

AU - Rheault, Michelle N.

AU - Kirchner, Varvara

AU - Dunn, Ty

AU - Kashtan, Clifford

AU - Nevins, Thomas

AU - Mauer, Michael

AU - Pruett, Timothy

AU - Kim, Youngki

AU - Najera, Lydia

AU - Hanna, Christian

AU - Kizilbash, Sarah

AU - Cook, Marie

AU - Cisek, Lars J.

AU - Gillingham, Kristen

AU - Yang, Yi

AU - Matas, Arthur

AU - Najarian, John

PY - 2017/4/1

Y1 - 2017/4/1

N2 - Background Advances in immunosuppression, surgical techniques, and management of infections in children receiving kidney transplants have affected outcomes. Study Design We analyzed a prospectively maintained database of pediatric kidney transplantations. Results From June 1963 through October 2016, we performed 1,056 pediatric kidney transplantations. Of these, 129 were in children less than 2 years old. The most common indications for transplant were congenital anomalies (dysplastic kidneys), obstructive uropathy, and congenital nephrotic syndrome. Living donors constituted 721 (68%) of all donors. The graft and patient survival rates remarkably improved for both deceased and living donor recipients (p = 0.001). Currently, graft survival rates for deceased donor recipients are 92% at 1 year, 76% at 5 years, and 57% at 10 years post-transplant; for living donor recipients, 96% at 1 year, 85% at 5 years, and 78% at 10 years. The graft half-life was 19 years in deceased donor recipients, compared with 25 years in living donor recipients (p ≤ 0.001). Acute rejection was the most common cause of graft loss in the first year post-transplant. The following risk factors were associated with an increased risk of graft loss: deceased donor grafts (p = 0.0001), retransplant (p = 0.02), ages 11 to 18 years (p = 0.001) and pre-transplant urologic issues (p = 0.04). Living donor grafts (p ≤ 0.0001) and pre-emptive transplants (p = 0.02) were associated with decreased risks of graft loss. Conclusions The success rates of pediatric kidney transplants have significantly improved. Pre-emptive kidney transplantation with a living donor graft continues to be superior and should be the choice in children with end-stage renal disease.

AB - Background Advances in immunosuppression, surgical techniques, and management of infections in children receiving kidney transplants have affected outcomes. Study Design We analyzed a prospectively maintained database of pediatric kidney transplantations. Results From June 1963 through October 2016, we performed 1,056 pediatric kidney transplantations. Of these, 129 were in children less than 2 years old. The most common indications for transplant were congenital anomalies (dysplastic kidneys), obstructive uropathy, and congenital nephrotic syndrome. Living donors constituted 721 (68%) of all donors. The graft and patient survival rates remarkably improved for both deceased and living donor recipients (p = 0.001). Currently, graft survival rates for deceased donor recipients are 92% at 1 year, 76% at 5 years, and 57% at 10 years post-transplant; for living donor recipients, 96% at 1 year, 85% at 5 years, and 78% at 10 years. The graft half-life was 19 years in deceased donor recipients, compared with 25 years in living donor recipients (p ≤ 0.001). Acute rejection was the most common cause of graft loss in the first year post-transplant. The following risk factors were associated with an increased risk of graft loss: deceased donor grafts (p = 0.0001), retransplant (p = 0.02), ages 11 to 18 years (p = 0.001) and pre-transplant urologic issues (p = 0.04). Living donor grafts (p ≤ 0.0001) and pre-emptive transplants (p = 0.02) were associated with decreased risks of graft loss. Conclusions The success rates of pediatric kidney transplants have significantly improved. Pre-emptive kidney transplantation with a living donor graft continues to be superior and should be the choice in children with end-stage renal disease.

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DO - 10.1016/j.jamcollsurg.2016.12.027

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