Predictors of graft survival in pediatric living-related kidney transplantrecipients

Background, A successful kidney transplant from a living-related donor (LRD ) remains the most effective renal replacement therapy for children with en d-stage renal failure. The use of LRD kidneys results in decreased time on dialysis, increased graft survival, and better function compared with kidne ys transplanted from cadaver donors. We retrospectively analyzed data from the United Network of Organ Sharing (UNOS) Scientific Renal Transplant Regi stry to determine risk factors for graft loss in children who received an L RD kidney. Methods. Data was obtained from the UNOS Scientific Renal Transplant Regist ry on 2418 children ranging in age from 0 to 18 years who underwent ent an LRD kidney transplantation between January 1988 and December 1994. Multivar iate analysis of graft survival was performed using Kaplan-Meier and Cox re gression models. Results. The effects of age, pretransplantation dialysis, early rejection, and race were found to significantly affect graft survival. Gender, peak pa nel-reactive antibody, and ABO blood type mere not found to be significant risk factors. Infants <2 years of age initially had the worst graft surviva l; however, over time their results stabilized, and at 7 years estimated gr aft survival was good (71%), Adolescents ranging in age from 13-18 years ha d the best initial graft survival, but as time went on graft survival worse ned (55%). patients who underwent pretransplantation dialysis had a relativ e risk for graft loss of 1.77 (P<0.001), whereas those who had an early rej ection had a relative risk for graft loss of 1.41 (P<0,,002). African-Ameri cans had a significantly higher relative risk for graft loss than either Ca ucasians (1.57, P<0.0005) or Hispanics (2.01, P<0.0003). Conclusions, Predictors of graft survival for children who receive LRD kidn ey transplants include age at transplantation, pretransplantation dialysis, early rejection, and race, Over time, adolescents and African-Americans se em to have the lowest graft survival.