PEDIATRIC KIDNEY TRANSPLANTATION: STUDYING DONOR AND RECIPIENT CHARACTERISTICS ON LONG-TERM OUTCOMES

Abstract

PURPOSE: To study donor and recipient characteristics on graft and pediatric patient survival rates. METHOD: We retrospectively reviewed 287 electronic charts of patients (under 18 year-old) underwent kidney transplantation from 01/1985 to 10/2012. Outcomes were analyzed based on the type of donor (deceased vs. living kidney donor) and recipient ESRD cause (nephrological vs. urological disease). The outcomes from recipients of deceased donors were also analyzed based on age of donors (< 17 vs. ≥ 18 years). Thereafter, the outcomes from first transplant and retransplant were compared apart. Graft and patient survival rates were compared with Kaplan-Meier curve and analyzed with Log-rank test. RESULTS: There were 309 pediatric kidney transplants in 287 children. 274 were first, 33 were second, and 2 were third grafts. 193 of 274 (67.2%) and 18 of 33 (54.5%) were living kidney transplantation. 62% of deceased donors were under 17 year-old. Regarding ESRD 195 (68%) patients presented with a nephrological cause, while 92 (32%) presented with a urological one. Of those with a urological cause, 28 (30.4%) underwent bladder augmentation. Mean follow-up was 13.7 (0–27) years. Overall, graft survival rate in one, 5 and 10 years of follow-up was 90.1%, 73.2% and 57.9%, while patient survival rate was 96.0%, 91.9% and 87.2%, respectively. There was a tendency of a higher graft survival rate in children with living kidney donors (p=0.058). There was no difference in the outcomes from first and second transplant, except by a higher immunological graft loss in retransplant group (p=0.032). There was also no difference in the graft survival rates regarding age of donor (p=0.630) and recipient ESRD cause (p=0.890). CONCLUSION: Long-term outcomes from pediatric kidney transplantation are not related to age of donor and recipient ESRD cause, since the urogenital abnormality has been corrected. Living kidney transplantation seems to present a higher graft survival rate.