Pediatric kidney transplant recipients generally have good outcomes post-transplantation. However, the younger age and longer life span after transplantation in the pediatric population make understanding the multifactorial nature of long-term graft survival critical. This investigation analyzes factors associated with 10-year survival to identify areas for improvement in patient care. Kaplan-Meier with log-rank test and univariable and multivariable logistic regression methods were used to retrospectively analyze 7785 kidney transplant recipients under the age of 18 years from January 1, 1998, until March 9, 2008, using United Network for Organ Sharing (UNOS) data. Our end-point was death-censored 10-year graft survival after excluding recipients whose grafts failed within one year of transplant. Recipients aged 5-18 years had lower 10-year graft survival, which worsened as age increased: 5-9 years (OR: 0.66; CI: 0.52-0.83), 10-14 years (OR: 0.43; CI: 0.33-0.55), and 15-18 years (OR: 0.34; CI: 0.26-0.44). Recipient African American ethnicity (OR: 0.67; CI: 0.58-0.78) and Hispanic donor ethnicity (OR: 0.82; CI: 0.72-0.94) had worse outcomes than other donor and recipient ethnicities, as did patients on dialysis at the time of transplant (OR: 0.82; CI: 0.73-0.91). Recipient private insurance status (OR: 1.35; CI: 1.22-1.50) was protective for 10-year graft survival. By establishing the role of age, race, and insurance status on long-term graft survival, we hope to guide clinicians in 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.

Factors associated with long-term graft survival in pediatric kidney transplant recipients

Kidney transplantation (Ktx) is generally performed during end stage renal disease due to a loss of the kidneys’ ability to filter wastes from the circulatory system. Acute graft-versus-host disease (GVHD) after Ktx is a life-threatening complication that progresses to organ failure, systemic complications, and death. The current study evaluated the significance of histologic findings of GVHD as obtained from skin biopsies following Ktx in swine. A swine model of Ktx with tacrolimus-based immunosuppression was used to assess possible correlations between acute-graft-cellular rejection and skin histological findings for prediction of GVHD. Animals were divided into a Ktx treatment group or a control group with no Ktx and skin and kidney biopsies were histologically assessed at postoperative days 0, 15, 30, 45 and 60. Skin samples were analyzed and classified from grade 1 to 4 of skin GVHD and the major histopathological changes of kidney acute cellular rejection were described using Banff’s score system. We observed a significant linear correlation between the histological grading values of skin biopsy changes and the histological grading values of kidney biopsies (Kendall’s tau_b=0.993) in the Ktx experimental group. No histological changes were observed in controls. Our findings demonstrate the diagnostic value of staging skin GVHD after Ktx and suggest it’s future utility for monitoring long term Ktx-induced changes.

/pdf/skin-and-kidney-histological-changes-in-graft-versus-host-3mii134zn3.pdf

Skin and kidney histological changes in graft-versus-host disease (GVHD) after kidney transplantation

BACKGROUND In this study, we examined the effects of nonimmunological factors on cadaver kidney transplant. METHODS Fifty-three cadaver kidney transplant recipients were studied. They were divided into two groups, Group I ( donor age or = 60, n=15). These patients were studied to determine whether donor age and recipient Body Mass Index (BMI) affected transplant outcome. RESULTS The 3 and 5-year overall graft / patient survival was 80.6 / 100% and 72.7 97.3%, respectively. The best S-Cr after transplantation was significantly (p<0.05) lower in Group I compared to Group II. The 1, 5 and 8-year graft survival was significantly (p<0.05) better in Group I. In the low BMI patients of Group II, 5-year graft survival was significantly (p<0.01) better than high BMI patients. DISCUSSION An aged cadaver donor was a risk factor for decreased posttransplant renal functions and lower graft survival. However, if a recipient with a low BMI can be selected, the outcome of cadaver kidney transplants from aged donors may be improved.

Clinical study on 53 cases of cadaveric kidney transplantation at Osaka City University Hospital.

Abstract Background Delayed graft function (DGF) is the most common complication experienced by kidney transplant recipients; therefore, it is critically important to develop an effective method of reducing DGF. Terlipressin can improve kidney function in patients with hepatorenal syndrome; therefore, we hypothesized that terlipressin plays a protective role in DGF and allograft function after transplantation. Methods In this retrospective, observational cohort study, we reviewed the medical records of 362 patients who underwent kidney transplantation at our organ transplant center between February 2015 and December 2019. The eligible recipients were divided into two groups based on whether they received terlipressin (Terlipressin group; n = 162) or dopamine (Control group; n = 200) on days 0–2 post-transplantation. The association between DGF and various clinical parameters was assessed using logistic regression analyses, and linear regression analysis was performed for predicting allograft function 30 days after transplantation. Results Compared to the Control group, the Terlipressin group had a significantly lower DGF rate (14.2 vs. 23.0%, P = 0.034), a higher estimated glomerular filtration rate during the two days post-transplantation (day 1: 9.54 ± 6.90 vs. 6.35 ± 4.95 mL/min/1.73m 2 , P &lt; 0.001; day 2: 15.35 ± 11.96 vs. 11.60 ± 10.49 mL/min/1.73 m 2 , P = 0.002), and a lower urinary tract infection rate (8.0 vs. 16.0%, P = 0.022). Terlipressin (odds ratio [OR], 0.544, 95% confidence interval [CI], 0.297–0.998, P = 0.049) and female recipient (OR, 0.366, 95% CI, 0.172–0.780, P = 0.009) were independent protective factors for DGF. DGF was negatively associated with allograft function 30 days after transplantation ( β = 130.210, 95% CI, 103.731–156.688, P &lt; 0.001). Conclusions Terlipressin reduced the incidence of DGF in kidney transplant recipients, indicating that it could be used as a new strategy for DGF prevention. 

https://www.researchsquare.com/article/rs-2976828/latest.pdf

Terlipressin reduces the incidence of delayed graft function in kidney transplant recipients

BIBLIOGRAFIJE ČLANOVA ODJELJENJA MEDICINSKIH NAUKA ANUBiH

Increasing gap between demand and availability of human kidneys for transplantation has forced a re-evaluation of the limits on donor age acceptability. The present study included 74 patients who underwent kidney transplantation in University Clinical Centre Tuzla. In an observational cohort study we assessed impact of donor age on post transplant renal function by analyzing following parameters: 24 hour urine output, creatinine clearance (Cr Cl) and glomerular filtration rate (GFR). Depending on donor age recipients were allocated in to two groups. Group I included patients who received renal graft from donors age up to 55 years, and Group II encountered recipients who received renal graft from donors older than 55 years. Our goal was to determine whether donor age over 55 years significantly diminishes renal graft function in first seven post transplant days. No statistically significant difference was found between Group I and II regarding 24 hour urine output. From second to fifth postoperative day creatinine clearance values were higher in the group of patients who received kidney from donors older than 55 years (47±19, 1 vs. 44, 4±20, 8). On the fifth, sixth and seventh post operative day GFR was significantly higher in patients who received renal graft from donors age up to 55 years (p 55 years is acceptable and may considerably expand the donor pool.

/pdf/influence-of-donor-age-on-renal-graft-function-in-first-3rx6ceteue.pdf

Influence of donor age on renal graft function in first seven post transplant days.

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Influence of donor age on renal graft function in first seven post transplant days.