Risk factors for chronic rejection in pediatric renal transplant recipients - A single-center experience

Patricia E. Birk, Arthur J. Matas, Kristen J. Gillingham, S. Michael Mauer, John S. Najarian, Blanche M. Chavers

Research output: Contribution to journalArticle

37 Citations (Scopus)

Abstract

Chronic rejection (CR) is the most common cause of graft loss beyond the 1st posttransplant year. The aim of this analysis was to identify the risk factors for the development of CR in pediatric renal transplant recipients. Between June 1984 and March 1994, 217 renal transplants were performed in children at our center. Immunosuppression included prednisone, azathioprine, cyclosporine (CsA), and prophylactic antibody. Using multivariate analysis, we studied the impact of the following variables on the development of biopsy-proven CR: age at transplant (≤ 5 years, > 5 years), gender, race, transplant number (primary, retransplant), donor source (cadaver, living donor), donor age (< 20 years, 20-49 years, > 49 years), number of ABDR mismatches (0, 1-2, 3-4, 5-6), number of DR mismatches (0, 1, 2), percentage peak panel reactive antibody (PRA) (≤ 50%, > 50%), percentage PRA at transplantation (≤ 50%, > 50%), dialysis pretransplant, preservation time > 24 h, acute tubular necrosis requiring dialysis, initial CsA dosage (≤ 5 mg/kg per day, > 5 mg/kg per day), CsA dosage at 1 year posttransplant (≤ 5 mg/kg per day, > 5 mg/kg per day), acute rejection (AR), number of AR episodes (ARE) (1, > 1), timing of AR (≤ 6 months, > 6 months), reversibility of AR (complete, partial), and infection [cytomegalovirus (CMV), non-CMV viral, bacterial]. Risk factors for the development of CR in pediatric renal transplant recipients were: AR (P < 0.0001, odds ratio 19.4), multiple ARE (> 1 vs. 1) (P < 0.0001, odds ratio 30.1), and high percentage peak PRA (> 50%) (P < 0.03, odds ratio 3.6).

Original languageEnglish (US)
Pages (from-to)395-398
Number of pages4
JournalPediatric Nephrology
Volume11
Issue number4
DOIs
StatePublished - Aug 1 1997

Fingerprint

Pediatrics
Transplants
Kidney
Antibodies
Dialysis
Tissue Donors
Living Donors
Azathioprine
Cytomegalovirus Infections
Prednisone
Cadaver
Immunosuppression
Cyclosporine
Necrosis
Multivariate Analysis
Transplantation
Odds Ratio
Biopsy
Transplant Recipients

Keywords

  • Acute rejection
  • Chronic rejection
  • Renal transplantation
  • Risk factors

Cite this

Risk factors for chronic rejection in pediatric renal transplant recipients - A single-center experience. / Birk, Patricia E.; Matas, Arthur J.; Gillingham, Kristen J.; Michael Mauer, S.; Najarian, John S.; Chavers, Blanche M.

In: Pediatric Nephrology, Vol. 11, No. 4, 01.08.1997, p. 395-398.

Research output: Contribution to journalArticle

@article{2cfede29f51649ec853a0d1e82396a33,
title = "Risk factors for chronic rejection in pediatric renal transplant recipients - A single-center experience",
abstract = "Chronic rejection (CR) is the most common cause of graft loss beyond the 1st posttransplant year. The aim of this analysis was to identify the risk factors for the development of CR in pediatric renal transplant recipients. Between June 1984 and March 1994, 217 renal transplants were performed in children at our center. Immunosuppression included prednisone, azathioprine, cyclosporine (CsA), and prophylactic antibody. Using multivariate analysis, we studied the impact of the following variables on the development of biopsy-proven CR: age at transplant (≤ 5 years, > 5 years), gender, race, transplant number (primary, retransplant), donor source (cadaver, living donor), donor age (< 20 years, 20-49 years, > 49 years), number of ABDR mismatches (0, 1-2, 3-4, 5-6), number of DR mismatches (0, 1, 2), percentage peak panel reactive antibody (PRA) (≤ 50{\%}, > 50{\%}), percentage PRA at transplantation (≤ 50{\%}, > 50{\%}), dialysis pretransplant, preservation time > 24 h, acute tubular necrosis requiring dialysis, initial CsA dosage (≤ 5 mg/kg per day, > 5 mg/kg per day), CsA dosage at 1 year posttransplant (≤ 5 mg/kg per day, > 5 mg/kg per day), acute rejection (AR), number of AR episodes (ARE) (1, > 1), timing of AR (≤ 6 months, > 6 months), reversibility of AR (complete, partial), and infection [cytomegalovirus (CMV), non-CMV viral, bacterial]. Risk factors for the development of CR in pediatric renal transplant recipients were: AR (P < 0.0001, odds ratio 19.4), multiple ARE (> 1 vs. 1) (P < 0.0001, odds ratio 30.1), and high percentage peak PRA (> 50{\%}) (P < 0.03, odds ratio 3.6).",
keywords = "Acute rejection, Chronic rejection, Renal transplantation, Risk factors",
author = "Birk, {Patricia E.} and Matas, {Arthur J.} and Gillingham, {Kristen J.} and {Michael Mauer}, S. and Najarian, {John S.} and Chavers, {Blanche M.}",
year = "1997",
month = "8",
day = "1",
doi = "10.1007/s004670050303",
language = "English (US)",
volume = "11",
pages = "395--398",
journal = "Pediatric nephrology (Berlin, Germany)",
issn = "0931-041X",
publisher = "Springer Verlag",
number = "4",

}

TY - JOUR

T1 - Risk factors for chronic rejection in pediatric renal transplant recipients - A single-center experience

AU - Birk, Patricia E.

AU - Matas, Arthur J.

AU - Gillingham, Kristen J.

AU - Michael Mauer, S.

AU - Najarian, John S.

AU - Chavers, Blanche M.

PY - 1997/8/1

Y1 - 1997/8/1

N2 - Chronic rejection (CR) is the most common cause of graft loss beyond the 1st posttransplant year. The aim of this analysis was to identify the risk factors for the development of CR in pediatric renal transplant recipients. Between June 1984 and March 1994, 217 renal transplants were performed in children at our center. Immunosuppression included prednisone, azathioprine, cyclosporine (CsA), and prophylactic antibody. Using multivariate analysis, we studied the impact of the following variables on the development of biopsy-proven CR: age at transplant (≤ 5 years, > 5 years), gender, race, transplant number (primary, retransplant), donor source (cadaver, living donor), donor age (< 20 years, 20-49 years, > 49 years), number of ABDR mismatches (0, 1-2, 3-4, 5-6), number of DR mismatches (0, 1, 2), percentage peak panel reactive antibody (PRA) (≤ 50%, > 50%), percentage PRA at transplantation (≤ 50%, > 50%), dialysis pretransplant, preservation time > 24 h, acute tubular necrosis requiring dialysis, initial CsA dosage (≤ 5 mg/kg per day, > 5 mg/kg per day), CsA dosage at 1 year posttransplant (≤ 5 mg/kg per day, > 5 mg/kg per day), acute rejection (AR), number of AR episodes (ARE) (1, > 1), timing of AR (≤ 6 months, > 6 months), reversibility of AR (complete, partial), and infection [cytomegalovirus (CMV), non-CMV viral, bacterial]. Risk factors for the development of CR in pediatric renal transplant recipients were: AR (P < 0.0001, odds ratio 19.4), multiple ARE (> 1 vs. 1) (P < 0.0001, odds ratio 30.1), and high percentage peak PRA (> 50%) (P < 0.03, odds ratio 3.6).

AB - Chronic rejection (CR) is the most common cause of graft loss beyond the 1st posttransplant year. The aim of this analysis was to identify the risk factors for the development of CR in pediatric renal transplant recipients. Between June 1984 and March 1994, 217 renal transplants were performed in children at our center. Immunosuppression included prednisone, azathioprine, cyclosporine (CsA), and prophylactic antibody. Using multivariate analysis, we studied the impact of the following variables on the development of biopsy-proven CR: age at transplant (≤ 5 years, > 5 years), gender, race, transplant number (primary, retransplant), donor source (cadaver, living donor), donor age (< 20 years, 20-49 years, > 49 years), number of ABDR mismatches (0, 1-2, 3-4, 5-6), number of DR mismatches (0, 1, 2), percentage peak panel reactive antibody (PRA) (≤ 50%, > 50%), percentage PRA at transplantation (≤ 50%, > 50%), dialysis pretransplant, preservation time > 24 h, acute tubular necrosis requiring dialysis, initial CsA dosage (≤ 5 mg/kg per day, > 5 mg/kg per day), CsA dosage at 1 year posttransplant (≤ 5 mg/kg per day, > 5 mg/kg per day), acute rejection (AR), number of AR episodes (ARE) (1, > 1), timing of AR (≤ 6 months, > 6 months), reversibility of AR (complete, partial), and infection [cytomegalovirus (CMV), non-CMV viral, bacterial]. Risk factors for the development of CR in pediatric renal transplant recipients were: AR (P < 0.0001, odds ratio 19.4), multiple ARE (> 1 vs. 1) (P < 0.0001, odds ratio 30.1), and high percentage peak PRA (> 50%) (P < 0.03, odds ratio 3.6).

KW - Acute rejection

KW - Chronic rejection

KW - Renal transplantation

KW - Risk factors

UR - http://www.scopus.com/inward/record.url?scp=0030873816&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0030873816&partnerID=8YFLogxK

U2 - 10.1007/s004670050303

DO - 10.1007/s004670050303

M3 - Article

C2 - 9260232

AN - SCOPUS:0030873816

VL - 11

SP - 395

EP - 398

JO - Pediatric nephrology (Berlin, Germany)

JF - Pediatric nephrology (Berlin, Germany)

SN - 0931-041X

IS - 4

ER -