Risk Factors in Long-Term Graft Survival in Pediatric Transplant Recipients

Post-transplant outcomes are generally good among pediatric kidney transplant recipients. However, it is important to understand the multifactorial nature of long-term graft survival due to the younger age and longer lifespan following transplantation in that patient population.

Anand and colleagues at Baylor College of Medicine, Houston, Texas, conducted a retrospective analysis to examine factors associated with 10-year survival with an eye toward identification of areas for improvement in care for pediatric kidney transplant recipients. Results of the analysis were reported in a virtual presentation at the 2021 American Transplant Congress. The presentation was titled Risk Factors Predicting Outcomes in Long-Term Pediatric Kidney Transplant Graft Survival.

Using data from the United Network for Organ Sharing, the researchers performed Kaplan-Meier analysis with log-rank tests as well as univariate and multivariate logistic regression methods to examine data on 7785 kidney transplant recipients from January 1, 1998, to March 9, 2008. Following exclusion of recipients whose graft failed within 1 year of transplant, the end point was death-censored 10-year graft survival.

Recipients 5 to 18 years of age had lower graft survival, which worsened as age increased: 5 to 9 years of age, odds ratio (OR), 0.66; 95% confidence interval (CI), 0.52-0.83; 10 to 14 years of age, OR, 0.43; 95% CI, 0.33-0.55); 15 to 18 years of age, OR, 0.34; 95% CI, 0.26-0.44. Outcomes were worse among recipients of African American ancestry (OR, 0.67; 95% CI, 0.58-0.78) and among those with Hispanic donor ethnicity (OR, 0.82, 95% CI, 0.72-0.94) compared with other recipient and donor ethnicities. Outcomes among patients on dialysis at the time of transplant were also worse than those among patients not dialysis-dependent at time of transplant (OR, 0.82; 95% CI, 0.73-0.91). Recipients with private insurance had improved 10-year graft survival compared with recipients with other insurance status (OR, 1.35; 95% CI, 1.22-1.50).

In summary, the researchers said, “By establishing the role of age, race, and insurance status on long-term graft survival, we hope to guide clinicians identifying patients at high risk for graft failure. This study highlights the need for increased allocation of resources and medical care to reduce the disparity in outcomes for certain patient populations.”

Source: Anand A, Malik T H, Dunson J, et al. Risk factors for predicting outcomes in long-term pediatric kidney transplant graft survival. Abstract of a presentation at the virtual American Transplant Congress 2021 (abstract #81), June 5, 2021.