OUTCOME OF RENAL TRANSPLANTATION IN NORTH AMERICAN CHILDREN ON PERITONEAL DIALYSIS - A NAPRTCS STUDY.

Abstract

834 Peritoneal Dialysis (PD) is a major form of renal replacement therapy and is employed in more than 60% of pediatric patients with end stage renal disease. However, there are no large studies on the outcome of renal transplantation (Tx) in North American children on PD. This study presents an analysis of North American Pediatric Renal Transplant Cooperative Study (NAPRTCS) data and compares graft and patient survival rates, incidence of acute tubular necrosis (ATN), acute rejection episodes, and causes of graft failure in pediatric patients maintained on PD prior to renal Tx with those maintained on hemodialysis (HD) and those undergoing preemptive Tx (PET). There were 2495 children (59% male; 61% Caucasian) who underwent primary renal Tx between 1/1/1992 and 12/31/1996. Of these, 1090 (43.7%) were on PD, 780 (31.3%) on HD, and 625 (25.1%) were PET. The mean (±S.D) duration of follow-up post Tx was (in months): 28.6±19.5 (PET), 27.5±19.1 (PD), and 27±18.9 (HD). The overall graft survival rate was similar in PD and HD groups; however, both were decreased compared to the PET group (3 year; 82% for both PD and HD; 89% PET; overall p=0.0003; PD vs. HD, p=NS). There was no difference in the overall patient survival rates in the three groups (96% PET, 95% PD, 97% HD). The incidence of ATN in the first seven days post Tx was higher in PD and HD patients compared to PET (11% PD and 12% HD vs. 2% PET, p<0.001; HD vs. PD, p=NS). There was no significant difference in the time to first acute rejection episode in any of the three groups. Both PD and HD groups had longer initial hospital stay (>9 days) compared to PET (72% for PD or HD vs. 63% PET; p<0.001). The major single cause of graft failure in each group was: PD - vascular thrombosis (20%), HD - chronic rejection (27%), PET - acute rejection and chronic rejection (21% each). Conclusion: We confirm small European and North American studies showing comparable patient and graft survival rates for children receiving PD prior to Tx to those achieved in HD patients. However, graft survival is improved in patients receiving PET compared to both PD and HD. Graft loss due to vascular thrombosis is more common in children receiving PD compared to HD.