Long-term outcomes of pediatric kidney transplantation: A single-center experience over the past 34years in Japan.

Abstract

To evaluate long-term outcomes and risk factors for graft loss in pediatric kidney transplantation over a 30-year period. We retrospectively assessed 400 consecutive kidney transplants carried out in 377 children during 1975-2009. Patients were stratified according to the immunosuppressive regimen (era1: methylprednisolone and azathioprine; era2: calcineurin inhibitor-based therapy, including methylprednisolone and azathioprine or mizoribine; era3: basiliximab induction therapy, including calcineurin inhibitors, methylprednisolone and mycophenolate mofetil). The median age and bodyweight at transplantation were 9.7years and 20.6kg, respectively. In total, 364 (91.0%) children received a living related donor transplantation. The acute rejection rate within 1year post-transplant decreased significantly from 61.0% in era1 to 14.5% in era3 (P<0.001). For transplant eras1-3, 1-year graft survival was 81%, 93% and 95%; 5-year graft survival was 66%, 86% and 93%; and 10-year graft survival was 47%, 79% and 89%, respectively. The overall 5-, 10- and 20-year patient survival rates were 96%, 93% and 88%, respectively. A Cox multivariate analysis identified cold ischemia time (hazard ratio 1.385, 95% confidence interval 1.251-1.603), acute rejection (hazard ratio 1.682, 95% confidence interval 1.547-3.842), re-transplant (hazard ratio 2.680, 95% confidence interval 1.759-3.982) and donor type (hazard ratio 2.957, 95% confidence interval 1.754-4.691) as independent risk factors for graft loss at 10years post-transplant. The progress of immunosuppressive therapy has led to a low incidence of acute rejection and a high graft survival rate across 30years of pediatric transplantation.