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Long-term outcomes of pediatric kidney transplantation: A single-center experience over the past 34 years in Japan.
- Source :
-
International journal of urology : official journal of the Japanese Urological Association [Int J Urol] 2020 Feb; Vol. 27 (2), pp. 172-178. Date of Electronic Publication: 2019 Dec 11. - Publication Year :
- 2020
-
Abstract
- Objectives: To evaluate long-term outcomes and risk factors for graft loss in pediatric kidney transplantation over a 30-year period.<br />Methods: We retrospectively assessed 400 consecutive kidney transplants carried out in 377 children during 1975-2009. Patients were stratified according to the immunosuppressive regimen (era 1: methylprednisolone and azathioprine; era 2: calcineurin inhibitor-based therapy, including methylprednisolone and azathioprine or mizoribine; era 3: basiliximab induction therapy, including calcineurin inhibitors, methylprednisolone and mycophenolate mofetil).<br />Results: The median age and bodyweight at transplantation were 9.7 years and 20.6 kg, respectively. In total, 364 (91.0%) children received a living related donor transplantation. The acute rejection rate within 1 year post-transplant decreased significantly from 61.0% in era 1 to 14.5% in era 3 (P < 0.001). For transplant eras 1-3, 1-year graft survival was 81%, 93% and 95%; 5-year graft survival was 66%, 86% and 93%; and 10-year graft survival was 47%, 79% and 89%, respectively. The overall 5-, 10- and 20-year patient survival rates were 96%, 93% and 88%, respectively. A Cox multivariate analysis identified cold ischemia time (hazard ratio 1.385, 95% confidence interval 1.251-1.603), acute rejection (hazard ratio 1.682, 95% confidence interval 1.547-3.842), re-transplant (hazard ratio 2.680, 95% confidence interval 1.759-3.982) and donor type (hazard ratio 2.957, 95% confidence interval 1.754-4.691) as independent risk factors for graft loss at 10 years post-transplant.<br />Conclusions: The progress of immunosuppressive therapy has led to a low incidence of acute rejection and a high graft survival rate across 30 years of pediatric transplantation.<br /> (© 2019 The Japanese Urological Association.)
Details
- Language :
- English
- ISSN :
- 1442-2042
- Volume :
- 27
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- International journal of urology : official journal of the Japanese Urological Association
- Publication Type :
- Academic Journal
- Accession number :
- 31826334
- Full Text :
- https://doi.org/10.1111/iju.14160