Pretransplant dialysis status and outcome of renal, transplantation in North American children: A NAPRTCS study

Abhay N. Vats, Lynn Donaldson, Richard N. Fine, Blanche M Chavers

Research output: Contribution to journalArticle

132 Citations (Scopus)

Abstract

Background. There are no large studies of the effect of pretransplant dialysis status on the outcome of renal transplantation (Tx) in children. This study evaluated the North American Pediatric Renal Transplant Cooperative Study (NAPRTCS) registry data for the outcome of Tx in pediatric patients who either (1) received their transplants preemptively or (2) were maintained on dialysis before receiving their transplants. Methods. We compared graft survival and patient survival rates, incidence of acute tubular necrosis (ATN), acute rejection episodes, and causes of graft failure in peritoneal dialysis (PD) patients with those maintained on hemodialysis (HD) and those undergoing preemptive Tx (PTx). Results. Primary Tx was performed in 2495 children (59% male; 61% Caucasian; 1090 PD, 780 HD, 625 PTx) between 1/1/1992 and 12/31/1996. The overall graft survival rates of the PD and HD groups were similar, but were less than that of the PTx group (3- year: 82% PD and HD, 89% PTx, overall P=0.0003). Improved graft survival in the PTx group was present only in recipients of grafts from living donors. There was no difference in the overall patient survival rate at 3 years, or in time to first acute-rejection episodes in the three groups. The incidence of ATN in the first 7 days post-Tx was higher in PD and HD patients than in PTx patients (11% PD and 12% HD vs. 2% PTx, P<0.001; HD vs. PD, P=NS). The major single cause of graft failure in each group was: PD, vascular thrombosis (20%); HD, chronic rejection (27%); PTx, acute and chronic rejection (21% each). Conclusion. NAPRTCS data show that graft survival is improved in patients receiving PTx, compared with those receiving PD and HD. Graft loss resulting from vascular thrombosis is more common in children who receive PD than in those receiving HD.

Original languageEnglish (US)
Pages (from-to)1414-1419
Number of pages6
JournalTransplantation
Volume69
Issue number7
DOIs
StatePublished - Apr 15 2000

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Peritoneal Dialysis
Kidney Transplantation
Renal Dialysis
Dialysis
Pediatrics
Transplants
Kidney
Graft Survival
Survival Rate
Blood Vessels
Thrombosis
Necrosis
Living Donors
Incidence
Registries

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Pretransplant dialysis status and outcome of renal, transplantation in North American children : A NAPRTCS study. / Vats, Abhay N.; Donaldson, Lynn; Fine, Richard N.; Chavers, Blanche M.

In: Transplantation, Vol. 69, No. 7, 15.04.2000, p. 1414-1419.

Research output: Contribution to journalArticle

Vats, Abhay N. ; Donaldson, Lynn ; Fine, Richard N. ; Chavers, Blanche M. / Pretransplant dialysis status and outcome of renal, transplantation in North American children : A NAPRTCS study. In: Transplantation. 2000 ; Vol. 69, No. 7. pp. 1414-1419.
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abstract = "Background. There are no large studies of the effect of pretransplant dialysis status on the outcome of renal transplantation (Tx) in children. This study evaluated the North American Pediatric Renal Transplant Cooperative Study (NAPRTCS) registry data for the outcome of Tx in pediatric patients who either (1) received their transplants preemptively or (2) were maintained on dialysis before receiving their transplants. Methods. We compared graft survival and patient survival rates, incidence of acute tubular necrosis (ATN), acute rejection episodes, and causes of graft failure in peritoneal dialysis (PD) patients with those maintained on hemodialysis (HD) and those undergoing preemptive Tx (PTx). Results. Primary Tx was performed in 2495 children (59{\%} male; 61{\%} Caucasian; 1090 PD, 780 HD, 625 PTx) between 1/1/1992 and 12/31/1996. The overall graft survival rates of the PD and HD groups were similar, but were less than that of the PTx group (3- year: 82{\%} PD and HD, 89{\%} PTx, overall P=0.0003). Improved graft survival in the PTx group was present only in recipients of grafts from living donors. There was no difference in the overall patient survival rate at 3 years, or in time to first acute-rejection episodes in the three groups. The incidence of ATN in the first 7 days post-Tx was higher in PD and HD patients than in PTx patients (11{\%} PD and 12{\%} HD vs. 2{\%} PTx, P<0.001; HD vs. PD, P=NS). The major single cause of graft failure in each group was: PD, vascular thrombosis (20{\%}); HD, chronic rejection (27{\%}); PTx, acute and chronic rejection (21{\%} each). Conclusion. NAPRTCS data show that graft survival is improved in patients receiving PTx, compared with those receiving PD and HD. Graft loss resulting from vascular thrombosis is more common in children who receive PD than in those receiving HD.",
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AB - Background. There are no large studies of the effect of pretransplant dialysis status on the outcome of renal transplantation (Tx) in children. This study evaluated the North American Pediatric Renal Transplant Cooperative Study (NAPRTCS) registry data for the outcome of Tx in pediatric patients who either (1) received their transplants preemptively or (2) were maintained on dialysis before receiving their transplants. Methods. We compared graft survival and patient survival rates, incidence of acute tubular necrosis (ATN), acute rejection episodes, and causes of graft failure in peritoneal dialysis (PD) patients with those maintained on hemodialysis (HD) and those undergoing preemptive Tx (PTx). Results. Primary Tx was performed in 2495 children (59% male; 61% Caucasian; 1090 PD, 780 HD, 625 PTx) between 1/1/1992 and 12/31/1996. The overall graft survival rates of the PD and HD groups were similar, but were less than that of the PTx group (3- year: 82% PD and HD, 89% PTx, overall P=0.0003). Improved graft survival in the PTx group was present only in recipients of grafts from living donors. There was no difference in the overall patient survival rate at 3 years, or in time to first acute-rejection episodes in the three groups. The incidence of ATN in the first 7 days post-Tx was higher in PD and HD patients than in PTx patients (11% PD and 12% HD vs. 2% PTx, P<0.001; HD vs. PD, P=NS). The major single cause of graft failure in each group was: PD, vascular thrombosis (20%); HD, chronic rejection (27%); PTx, acute and chronic rejection (21% each). Conclusion. NAPRTCS data show that graft survival is improved in patients receiving PTx, compared with those receiving PD and HD. Graft loss resulting from vascular thrombosis is more common in children who receive PD than in those receiving HD.

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