Risk factors for chronic rejection in pediatric renal transplant recipients - A single-center experience

Patricia E. Birk, Arthur J. Matas, Kristen J. Gillingham, S. Michael Mauer, John S. Najarian, Blanche M. Chavers

Research output: Contribution to journalArticlepeer-review

38 Scopus citations

Abstract

Chronic rejection (CR) is the most common cause of graft loss beyond the 1st posttransplant year. The aim of this analysis was to identify the risk factors for the development of CR in pediatric renal transplant recipients. Between June 1984 and March 1994, 217 renal transplants were performed in children at our center. Immunosuppression included prednisone, azathioprine, cyclosporine (CsA), and prophylactic antibody. Using multivariate analysis, we studied the impact of the following variables on the development of biopsy-proven CR: age at transplant (≤ 5 years, > 5 years), gender, race, transplant number (primary, retransplant), donor source (cadaver, living donor), donor age (< 20 years, 20-49 years, > 49 years), number of ABDR mismatches (0, 1-2, 3-4, 5-6), number of DR mismatches (0, 1, 2), percentage peak panel reactive antibody (PRA) (≤ 50%, > 50%), percentage PRA at transplantation (≤ 50%, > 50%), dialysis pretransplant, preservation time > 24 h, acute tubular necrosis requiring dialysis, initial CsA dosage (≤ 5 mg/kg per day, > 5 mg/kg per day), CsA dosage at 1 year posttransplant (≤ 5 mg/kg per day, > 5 mg/kg per day), acute rejection (AR), number of AR episodes (ARE) (1, > 1), timing of AR (≤ 6 months, > 6 months), reversibility of AR (complete, partial), and infection [cytomegalovirus (CMV), non-CMV viral, bacterial]. Risk factors for the development of CR in pediatric renal transplant recipients were: AR (P < 0.0001, odds ratio 19.4), multiple ARE (> 1 vs. 1) (P < 0.0001, odds ratio 30.1), and high percentage peak PRA (> 50%) (P < 0.03, odds ratio 3.6).

Original languageEnglish (US)
Pages (from-to)395-398
Number of pages4
JournalPediatric Nephrology
Volume11
Issue number4
DOIs
StatePublished - Aug 1997

Keywords

  • Acute rejection
  • Chronic rejection
  • Renal transplantation
  • Risk factors

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