Analysis of Factors Related to the Success of Pediatric Kidney Transplantation: A 35 Years Experience

Abstract

IntroductionDespite the significant improvement results over the past 20 years, pediatric kidney transplantation remains a challenge. Chronic rejection, thrombosis and recurrence of the primary disease are frequent causes of graft loss that have been little studied. Therefore, our objective is to analyze factors related to a better prognosis, which can be used to improve future strategies to allow higher pediatric transplant success rates. MethodologyRetrospective cohort study with patients under 15 years-old submitted for kidney transplantation at the Hospital das Clínicas da UNICAMP between January 1st, 1987 and January 1st, 2022. Age, patient weight, time and type of dialysis, use of anticoagulation, complications, ischemia time and donor weight were analyzed and related to graft loss. The significance level adopted for the statistical tests was 5%. Results192 medical records were analyzed. Mean follow-up time was 11 years and mean graft duration 8,5 years. The main causes of graft loss were chronic dysfunction, thrombosis and acute cellular rejection. Thrombosis presented significantly with the donor's body mass index and second transplantation. There was no correlation between the analyzed variables and chronic dysfunction or acute cellular rejection. DiscussionThrombosis remains the main cause of early graft loss, followed by acute cellular rejection. Measures such as thrombophilia screening and thromboprophylaxis have been proposed to improve results, however they are still not standardized. ConclusionThe main causes of graft loss were chronic dysfunction, thrombosis and acute cellular rejection. Only the thrombosis was related to the donor's body mass index and a second transplantation.