Pediatric Kidney Transplant Research Articles

Anemia after kidney transplantation.

Anemia is a frequent complication in pediatric kidney transplant recipients (KTR) with a variable reported prevalence estimated between 20 and 80% depending on how defined. Causes of and risk factors for post-transplantation anemia (PTA) are multifactorial with iron deficiency being the primary cause of early PTA (within the first 6months after transplantation) and impaired glomerular filtration rate (GFR) commonly responsible for late PTA (after 6months). Medications, viral infections, chronic inflammation, and comorbidities also play a role. PTA has relevant long-term consequences and is a potential risk factor for allograft dysfunction, cardiovascular morbidity, and mortality. Thus, an anemia evaluation, approximately 3months post-transplantation, is recommended in order to start early treatment and improve prognosis. Iron status, vitamin B12, folate, markers of hemolysis, and viral PCR should be checked, and medications, in particular combinations of medications, should be carefully evaluated. PTA treatment may be challenging and should be directed to the underlying causes. Iron supplementation and erythropoietin therapy, not extensively used in KTR, may be indicated. Every effort should be made to avoid blood transfusions in the pre-transplant period to avoid allosensitization. Anemia should be corrected to prepare candidates for kidney transplantation in order to reduce the need for perioperative blood transfusions as well.

Emulation of the control cohort of a randomized controlled trial in pediatric kidney transplantation with Real-World Data from the CERTAIN Registry

BackgroundRandomized controlled trials in pediatric kidney transplantation are hampered by low incidence and prevalence of kidney failure in children. Real-World Data from patient registries could facilitate the conduct of clinical trials by substituting a control cohort. However, the emulation of a control cohort by registry data in pediatric kidney transplantation has not been investigated so far.MethodsIn this multicenter comparative analysis, we emulated the control cohort (n = 54) of an RCT in pediatric kidney transplant patients (CRADLE trial; ClinicalTrials.gov NCT01544491) with data derived from the Cooperative European Paediatric Renal Transplant Initiative (CERTAIN) registry, using the same inclusion and exclusion criteria (CERTAIN cohort, n = 554).ResultsMost baseline patient and transplant characteristics were well comparable between both cohorts. At year 1 posttransplant, a composite efficacy failure end point comprising biopsy-proven acute rejection, graft loss or death (5.8% ± 3.3% vs. 7.5% ± 1.1%, P = 0.33), and kidney function (72.5 ± 24.9 vs. 77.3 ± 24.2 mL/min/1.73 m2P = 0.19) did not differ significantly between CRADLE and CERTAIN. Furthermore, the incidence and severity of BPAR (5.6% vs. 7.8%), the degree of proteinuria (20.2 ± 13.9 vs. 30.6 ± 58.4 g/mol, P = 0.15), and the key safety parameters such as occurrence of urinary tract infections (24.1% vs. 15.5%, P = 0.10) were well comparable.ConclusionsIn conclusion, usage of Real-World Data from patient registries such as CERTAIN to emulate the control cohort of an RCT is feasible and could facilitate the conduct of clinical trials in pediatric kidney transplantation.Graphical abstractA higher resolution version of the Graphical abstract is available as Supplementary information

Bronchiectasis in children following kidney transplantation in New Zealand.

Bronchiectasis is an acquired chronic respiratory condition with a relatively high incidence in New Zealand children. Bronchiectasis following kidney transplant has been reported internationally. This study aimed to identify the incidence rate of bronchiectasis following paediatric kidney transplantation. Secondary aims were to assess the impact on kidney allograft function and identify risk factors that might prompt earlier diagnosis. Case control study of children who developed bronchiectasis following kidney transplant in New Zealand. All children who were transplanted during the 16-year period from 2001 to 2016 were included. Each identified case was matched with two controls (children who did not develop bronchiectasis and received a kidney transplant within the closest time period to their matched case). Data were collected on baseline demographics, clinical variables, immunosuppression and allograft function. Of 95 children who had a kidney transplant during the specified time period, eight (8.4%) developed bronchiectasis at a median of 4 years post-transplant. The mean incidence rate of bronchiectasis was 526 cases per 100 000 paediatric kidney transplant population per year. The majority of children were Māori or Pasifika ethnicity and lived in areas of greater socio-economic deprivation. Immunosuppression burden and allograft function were not significantly different between groups. The incidence rate of bronchiectasis following paediatric kidney transplantation is substantially higher than the baseline paediatric incidence rate in New Zealand. A high index of suspicion for bronchiectasis and prompt investigation of children post kidney transplantation with a history of recurrent lower respiratory tract infection or chronic cough are advised.

Management of pediatric dialysis and kidney transplant patients after natural or man-made disasters.

Pediatric patients on kidney replacement therapy (KRT) are among the most vulnerable during large-scale disasters, either natural or man-made. Hemodialysis (HD) treatments may be impossible because of structural damage and/or shortage of medical supplies, clean water, electricity, and healthcare professionals. Lack of peritoneal dialysis (PD) solutions and increased risk of infectious/non-infectious complications may make PD therapy challenging. Non-availability of immunosuppressants and increased risk of infections may result in graft loss and deaths of kidney transplant recipients. Measures to mitigate these risks must be considered before, during, and after the disaster including training of staff and patients/caregivers to cope with medical and logistic problems. Soon after a disaster, if the possibility of performing HD or PD is uncertain, patients should be directed to other centers, or the duration and/or number of HD sessions or the PD prescription adapted. In kidney transplant recipients, switching among immunosuppressants should be considered in case of non-availability of the medications. Post-disaster interventions target treating neglected physical and mental problems and also improving social challenges. All problems experienced by pediatric KRT patients living in the affected area are applicable to displaced patients who may also face extra risks during their travel and also at their destination. The need for additional local, national, and international help and support of non-governmental organizations must be anticipated and sought in a timely manner.

Hypogammaglobulinemia in pediatric kidney transplant recipients

Infections remain the most common cause of hospitalization after kidney transplantation, contributing to significant post-transplant morbidity and mortality. There is a growing body of literature that suggests that immunoglobulins may have a significant protective role against post-transplant infections, although the literature remains sparse, inconsistent, and not well publicized among pediatric nephrologists. Of great concern are data indicating a high prevalence of immunoglobulin abnormalities following transplantation and a possible link between these abnormalities and poorer outcomes. Our educational review focuses on the epidemiology and risk factors for the development of immunoglobulin abnormalities after kidney transplantation, the outcomes in patients with low immunoglobulin levels, and studies evaluating possible interventions to correct these immunoglobulin abnormalities.

Post-Traumatic Stress Disorder and Post-Traumatic Growth following Kidney Transplantation.

Kidney transplantation (KT) is a life-saving therapy for kidney failure. However, KT recipients can suffer from debilitating depression, post-traumatic stress disorder (PTSD), and suicide. In contrast to PTSD, post-traumatic growth (PTG) is a positive psychologic change in response to a challenging situation. PTG has been studied in other chronic diseases, but less is known about its role in the setting of KT. We sought to elucidate the prevalence, predictors, and the effect of PTSD and PTG on post-KT outcomes. We also considered the roles of benefit finding and resilience. In a literature review, we identified publications that examined PTSD, PTG, benefit finding, and/or resilience in KT recipients. We excluded case reports and first-person narratives. Publications meeting the specified criteria after full text review underwent data abstraction and descriptive analysis. Of the 1013 unique citations identified, 39 publications met our criteria. PTSD was the most common construct evaluated (16 publications). Resilience was studied in 11 publications, PTG in nine, and benefit finding in five. Up to 21% of adult and 42% of pediatric KT recipients may experience PTSD, which is associated with lower quality of life (QOL), impaired sleep, and other psychiatric comorbidity. PTG was associated with improved QOL, kidney function, and reduced risk of organ rejection. Although benefit finding tended to increase post KT, resilience remained stable post KT. Like PTG, resilience was associated with lower psychologic distress and increased treatment adherence and confidence in the health care team. PTG, resilience, and benefit finding appear to reduce the risk of PTSD, promote well-being, and reduce risk of graft failure in KT recipients. Future research to understand these relationships better will allow clinicians and researchers to develop interventions to promote PTG, resilience, and benefit finding, and potentially improve post-transplant outcomes such as adherence and reducing risk of organ rejection.

Human kidney-derived hematopoietic stem cells can support long-term multilineage hematopoiesis

Long-term multilineage hematopoietic donor chimerism occurs sporadically in patients who receive a transplanted solid organ enriched in lymphoid tissues such as the intestine or liver. There is currently no evidence for the presence of kidney-resident hematopoietic stem cells in any mammal species. Graft-versus-host-reactive donor T cells promote engraftment of graft-derived hematopoietic stem cells by making space in the bone marrow. Here, we report full (over 99%) multilineage, donor-derived hematopoietic chimerism in a pediatric kidney transplant recipient with syndromic combined immune deficiency that leads to transplant tolerance. Interestingly, we found that the human kidney-derived hematopoietic stem cells took up long-term residence in the recipient's bone marrow and gradually replaced their host counterparts, leading to blood type conversion and full donor chimerism of both lymphoid and myeloid lineages. Thus, our findings highlight the existence of human kidney-derived hematopoietic stem cells with a self-renewal ability able to support multilineage hematopoiesis.

Growth hormone treatment in the pre-transplant period is associated with superior outcome after pediatric kidney transplantation

Growth hormone treatment in the pre-transplant period is associated with superior outcome after pediatric kidney transplantation

Arterial stiffness and blood pressure increase in pediatric kidney transplant recipients

BackgroundPulse wave velocity (PWV) is a measure of arterial stiffness. We investigated PWV and blood pressure (BP) to determine to what extent BP changes contribute to arterial stiffness, and secondly, to identify influencing factors on BP in children after kidney transplantation.MethodsSeventy children ≥ 2.5 years post-transplantation with at least two PWV measurements were included. Changes of systolic (Δ SBP) and diastolic BP (Δ DBP) were classified into “stable/decreasing,” “1–10 mmHg increase,” and “ > 10 mmHg increase.” Linear mixed modeling for PWV z-score (PWVz) adjusted either for Δ SBP or Δ DBP was performed. An extended dataset with monthly entries of BP, immunosuppression, and creatinine was obtained in 35 participants over a median of 74 months to perform linear mixed modeling for SBP and DBP.ResultsPWVz increased with a rate of 0.11/year (95% CI 0.054 to 0.16). Compared to participants with stable BP, those with 1–10-mmHg SBP and DBP increase showed a higher PWVz of 0.59 (95% CI 0.046 to 1.13) and 0.86 (95% CI 0.43 to 1.30), respectively. A > 10-mmHg BP increase was associated with an even higher PWVz (SBP β = 0.78, 95% CI 0.22 to 1.34; DBP β = 1.37, 95% CI 0.80 to 1.94). Female sex and participants with lower eGFR showed higher PWVz.In the extended analysis, DBP was positively associated with cyclosporin A and everolimus trough levels.ConclusionsA higher increase of PWV is seen in patients with greater BP increase, with higher cyclosporin A and everolimus trough levels associated with higher BP. This emphasizes the role of BP as a modifiable risk factor for the improvement of cardiovascular outcome after transplantation.Graphical abstractA higher resolution version of the Graphical abstract is available as Supplementary information

A modified Kidney Donor Risk Index for pediatric kidney transplant recipients.

The Kidney Donor Risk Index (KDRI) by Rao et al. was developed to measure the quality of kidney allografts. While Rao's KDRI has been found to be a robust measure of kidney allograft survival for adult kidney transplant recipients, many studies have indicated the need to create a distinct pediatric KDRI. Our retrospective study utilized data from the United Network for Organ Sharing database. We examined 9295 deceased donor recipients' data for age < 18years from 1990 to 2020. We performed a multivariate Cox regression to determine the significant recipient and transplant factors impacting pediatric kidney allograft survival. Multivariate analysis found 5 donor factors to be independently associated with graft failure or recipient death: age, female sex, anoxia as the cause of death, history of cigarette use, and cold ischemia time. Using receiver operator characteristic (ROC) curve analysis and analyzing the predictive value of each KDRI at 1, 5, and 10years, the proposed pediatric KDRI had a statistically significant and higher predictive value for pediatric recipients at 5 (0.60 versus 0.57) and 10years (0.61 versus 0.57) than the Rao KDRI. The proposed pediatric KDRI may provide a more accurate and simpler index to assess the quality of kidney allografts for pediatric recipients. However, due to the mild increase in predictive capabilities over the Rao index, the study serves as a proof of concept to develop a pediatric KDRI. Further studies should focus on increasing the index's predictive capabilities. A higher resolution version of the Graphical abstract is available as Supplementary information.

Pediatric kidney transplant recipients with and without underlying structural kidney disease have a comparable risk of hospitalization associated with urinary tract infections

IntroductionUrinary tract infections (UTIs) are a common and potentially serious kidney transplant complication. Pediatric kidney transplants are potentially at increased risk for UTIs when structural kidney disease is the underlying end-stage kidney disease (ESKD) etiology. The objective of this manuscript is to determine if children with structural kidney disorders are more prone to UTIs post kidney transplant.Materials and methodsHospitalizations for pediatric kidney transplant recipients were retrospectively reviewed over a 4-year period for UTIs in the diagnostic codes. The patient’s age, sex, graft age, underlying diagnosis for cause of ESKD, symptoms at presentation, urinalysis results, and urine culture results were recorded. UTI rates, febrile UTI rates, and UTI rates in the 1st year post-transplant were compared between children with ESKD due to structural vs. non-structural kidney disease.ResultsOverall, 62 of 145 pediatric patients with kidney transplants accounted for 182 hospitalizations for kidney transplant complications over the 4-year study period. UTIs were components of 34% of the hospitalizations. Overall, UTI rates, febrile UTI rates, and UTI rates for the 1st year post kidney transplant were comparable for children with vs. without structural ESKD etiologies.ConclusionUrinary tract infections are frequent components of hospitalizations for pediatric kidney transplant recipients. Children with and without structural kidney disease as an ESKD etiology have similar UTI rates indicating that UTI susceptibility is primarily due to the transplant process and/or medication regimens. UTIs represent a potentially modifiable risk factor for pediatric kidney transplant complications.

Analysis of prognostic factors of pediatric kidney transplantation

Objective: To evaluate the short-and mid-term efficacy of pediatric kidney transplantation and the risk factors for kidney graft and recipient. Methods: The baseline data and postoperative complications of pediatric donors and recipients of 284 kidney transplants were retrospectively analyzed in the Department of Kidney Transplantation in the First Affiliated Hospital of Zhengzhou University from August 2010 to May 2021 and all subjects were followed up until December 31, 2021. According to the survival status of donors and recipients, they were divided into the graft-loss group and the graft-survival group, and the recipient death group and survival group, respectively. Univariate comparison between groups was performed by Log-rank test, and Cox proportional risk model was used to explore the independent risk factors for the graft and recipient survival. Results: Among the 284 children recipients, 184 cases (64.8%) were male and 100 cases(35.2%) were female, and 19 cases (6.7%) were living relative donor renal transplantation, 19 cases (6.7%) were preemptive transplantation, and 8 cases were secondary transplantation. The age of 284 recipients at the time of transplantation was 13.0 (9.0, 15.0) years, among whom 29 cases aged 0-6 years, 96 cases aged 7-11 years old, and 159 cases aged 12-18 years. The 1, 3, and 5 year survival rates were 92.3%, 88.9% and 84.8% for the kidney grafts, and were 97.1%, 95.6% and 94.4% for the recipients, respectively. Multivariate analysis showed postoperative acute rejection (HR=3.14, 95%CI 1.38-7.15, P=0.006) and perioperative vascular complications (HR=4.73, 95%CI 2.03-11.06, P<0.001) were independent risk factors for the survival of kidney graft. Postoperative infection (HR=14.23, 95%CI 3.45-58.72, P<0.001) was an independent risk factor for the postoperative mortality of recipients. Conclusions: Pediatric kidney transplantation shows a good short-and mid-term prognosis. Postoperative acute rejection and perioperative vascular complications are the risk factors for the survival of kidney graft, and postoperative infection is the risk factor affecting the survival of recipient.

P8.065: COVID-19 and Pediatric Kidney Transplantation: Iberoamerican Multicentric Study

Introduction: Concern on the effect of COVID-19 in children recipients of kidney transplant (KT) lead to an initial decline in the transplantation activity. Our aim is to present graft and clinical outcomes of a multicenter cohort of pediatric KT performed during COVID-19 pandemic and compare it with an historic control group. Our secondary goal is to report the clinical evolution of children who suffered COVID-19 after transplantation. Methods: A retrospective analysis in seven pediatric KT centers of Iberoamerica, from January 2019 to December 2020 was done. In the included institutions, 168 pediatric KT were performed: 97 patients were control group (year 2019) and 71 the study group (year 2020). Baseline demographics and comorbidities were comparable. Graft outcome showed no significant differences in terms of the need of post transplant renal replacement therapy and glomerular filtration rate in the last visit. Graft hydronephrosis, urinary tract infection, and other complications were similar (Table 1). Results: Six (8,4%) out of 71 patients transplanted in 2020 developed COVID 19 after the transplant. The infection occurred at a mean 71,8 days after the transplant (range: 5-214 days). Three patients were asymptomatic, two presented with fever and one with cough. Three patients were managed on an outpatient basis, two were admitted but remain in a common room, whereas one child required hospitalization in intensive care unit but, without the need of mechanical ventilatory assistance. In 3 patients mycophenolate was suspended, and in the other 3 there were no changes in the immunosuppressive scheme. There were no mayor respiratory complications such as COVID-19 pneumonia or acute respiratory distress syndrome. Hospital stay was a mean of 13 days (range: 0-39). All six patients had good graft outcome, with no need renal replacement therapy, with a mean glomerular filtration rate of 86,36 mL/min/1.73 m2 (range:58 -126). One patient had recurrence of original renal disease. Conclusion: Despite initial concerns about the increased risk of severe complications of COVID-19 and the graft survival in children with KT, our multicentric series showed similar initial graft outcome and no mayor respiratory complications. Longer follow up is needed to assess the long-term evolution of these grafts and patients.

243.3: Immune Subset Differences by Flow Cytometry between Paediatric Kidney Transplant Recipients and Healthy Matching-age Paediatric and Adult Controls.

Aim: Determine differences in immunophenotype of paediatric kidney transplant recipients vs. healthy matching-age paediatric and adult controls by minimum blood volume. Methods: Absolute cell-count and leukocyte-profiling panels (46 fluorochrome-conjugated mouse-anti-human antibodies) for T cell, Treg, B, NK, DCs, and monocyte subsets were used to quantify immune-cell populations for 8 paediatric kidney transplant (PKTx) recipients, 5 healthy matching-age paediatric and 8 adult controls. Whole-blood sample (1050µl) were used for flow-cytometry analysis. Results: Absolute number of immune-cell subsets were in normal range for all groups. Age has correlation to CD45RO+memory T cells, but not to CD27+IgD-memory B cells. Healthy children had higher proportions of CD4-CD8-T (13.7±5.8 vs 7±4.3%, p=0.03) and γδT-cells (12±5.7vs 5.4±4.6%, p=0.04), CD4+CD25+CD127-Tregs (10±1.4 vs 7±1.6%, p<0.01), lower proportion of HLADR+CD45RA-CD4+ (0.03±0.04vs 7.42±5.64%, p<0.01), HLADR+CD45RA-CD8+ (0.0012±0.0018 vs 8±5.1%, p =0.04) T-cells compared to adults. HLA-DR was upregulated on both CD4+CD45RA- and CD8+CD45RA-T cells in PKTx, whilst CD183 (CXCR3) on CD4+CD45RO+ T-cells was downregulated. Compared to their healthy counterparts, PKTx had lower proportions of CD27+CD38lowclass-switch memory B-cells (38±7.6 vs 53±5.3%, p<0.01), non-classical monocytes (1.9±0.9 vs 5.8±1.1%, p<0.001), Tregs [CD4+CD25+CD127-Tregs (4.8±1.7% vs 10±1.4%, p<0.001) and CD4+FOXP3+Tregs (2.8±0.85% vs 6.3±1.3%, p<0.01)]. A small proportion of CD127+CD45RO+FOXP3 (2-5%) were observed in all groups. There was no difference in proportions of NK and DC between transplant vs control population. Conclusion: Immune profiling by multi-colour flow cytometry revealed differences by ages and after transplantation and offers valuable insight into unique cell subset changes present in the transplant population that could be targeted clinically or to monitor patient condition.

P13.08: Pediatric Kidney Transplantation in the Middle-East: Challenges and Solutions

P13.08: Pediatric Kidney Transplantation in the Middle-East: Challenges and Solutions

P13.07: Detecting Subclinical Rejection Using dd-cfDNA in Pediatric Kidney Transplant

P13.07: Detecting Subclinical Rejection Using dd-cfDNA in Pediatric Kidney Transplant

347.8: Impact of Gender on Kidney Transplantation Practices: A Single Centre Report From Largest Public-Sector Transplant Center of India

Introduction: There is scarcity assessing the true burden of gender disparity in organ transplantation from the developing world. Methods: We analysed data from 1997 to March 2020, comprised of a total of 5838 kidney transplants including 943 deceased donor kidney transplants (DDKTs) in addition to 4895 LDKTs including 440 living donor kidney paired donations. We excluded the data from pandemic period to avoid bias of low transplant volume in the period. Results: A majority of male recipients have received DDKT. Interestingly, there have, however, also been more male deceased donors (Figure 2A, 2B). Of 831 DDKT recipients between 1997 and 2018 in our center, 68% have been males and 32% females. Overall, female donors constituted 71% of the living donor pool. Female donors are most frequently mothers (33.7%), wives (20.1%), and infrequently daughters (0.4%). When parents donate, it is most frequently the mother (73%). Donation rates of Fathers have increased from 10% in 1999 to 15% in 2020, reflecting a trend that focuses on the well-being of the nuclear family. For married couples, 90% of donors come from wives based on sociocultural reasons and a financial dependency on the husband. Figure 1 indicates that females (mother and wife) contribute to 50% of living donors. The contribution of Mothers increased from 20% in 1999 to 30% in 2020. Donations by other than near-related donors (near-related donors include parents, spouse, siblings, children, and grandparents) declined from 25% in 1999 to 3% in 2020 (Figure 1A, 1B). THOA has permitted kidney exchanges, also called swap transplants since 2011. From 2000 to 2020, 9.3% of all living donors have been through paired kidney exchanges. Female donors have contributed with (78%) to this program. Gender disparities become even more pronounced in pediatric kidney transplantation (Figure 3). Conclusion: Gender disparity in transplantation our report is evident and can be combated by and the developing implementation of an equitable deceased donor allocation system, prioritizing difficult to match female recipients in a team effort with local living donor champions ensuring logistics and social support. The decision to donate among women is highly influenced by their roles within the family and society. Although the implementation of those policies is relevant, the hard work addressing social biases and financial disadvantages will need to happen in parallel.

216.5: Beneficial Addition of Donor-derived Cell-free DNA Testing in Pediatric Kidney Transplantation

216.5: Beneficial Addition of Donor-derived Cell-free DNA Testing in Pediatric Kidney Transplantation

243.2: Pediatric Kidney Transplantation in Argentina: Is Delayed Graft Function a Problem? Results of a Multicenter Study

Introduction: Delayed graft function (DGF) is a manifestation of acute kidney injury occurring after kidney transplantation (KTx). Incidence of DGF in pediatric KTx recipients is variable (10% to 25%) due to different definitions of DGF and different subgroups of kidney donors. It is associated with an increased risk of graft loss in adult KTx. Several factors related to donor, recipient, and organ procurement/transplantation procedures may increase the risk of DGF. The aim of our study was to evaluate the cumulative incidence of DGF in a children who received a kidney graft from a brain-dead donor, its impact on patient and graft survival, and to identify predictive risk factors of DGF. Methods: A retrospective multicenter study was conducted including recipients under 18 years of age who underwent KTx from a brain-dead donor between January 1, 2015 and December 31, 2017. DGF was defined as the need for dialysis within the first week after KTx. Data were obtained from the clinical records of the patients and from the Registry and Management System of Argentina (SINTRA) and were analyzed using MedCalc® Statistical Software version 20.014; 2021. Results: We analyzed 239 KTx performed at 17 centers. Of the recipients 54.4% were male, median age at Tx was 13.7 yr (r: 2.8 -17.9), weight 30 kg (r: 7 - 82), BMI 17 Kg/m2 (r: 11 - 36). Etiology of ESRD: CAKUT 30%, glomerular diseases with risk of recurrence 24.3%, typical HUS 3.8%, others 29.7%, and unknown 12.2%. Pre-emptive KTx was performed in 18.8% of patients, 39.7% were receiving hemodialysis, and 41.5% peritoneal dialysis. Median of time on dialysis was 2.62 yr (r: 0.12 - 9.8). Of the donors 70.7% were male, median age was 17.6 yr (r: 2.8 - 55), BMI 23 Kg/m2 (r: 17 - 35), BMI ratio donor/recipient 1.35, and pre-ablation serum creatinine 0.82 mg/dl (r: 0.6 - 2.6). Cause of death was trauma in 57%, vascular in 24%, and others in 19%. Cold ischemia time was 16.6 hours (r: 4.2 - 42), HLA mismatches ≼ 3: 54% and > 3: 46 %. Multiple-organ donor in 84.5%. Overall, 59 patients (24.7%) developed DGF. Patients without DGF had better graft survival at 1 (96% vs 78%) and 3 yrs of follow-up (89% vs 73%) p= 0.001. There were no significant differences in patient survival between both groups at the 3-year follow-up (95% vs 91%). Incidence of early AR (90 days post Tx) was higher in patients with DGF (34.5% vs 10.6%) p= 0.0001. In univariate analysis risk factors for DGF were: age at Tx > 13.7 yr, male gender, glomerular disease with risk of recurrence, hemodialysis as prior to KTx, and time on dialysis > 1 yr. In multivariate analysis independent risk factors for DGF were: time on dialysis > 1 yr (OR 9.2 - 95% CI 2.1 - 39) and age at KTx > 13.7 yr (OR 1.09 - 95% CI 1.01 - 1.18). Conclusion: In our cohort, cumulative incidence of DGF was higher than that reported by other authors. Patients with DGF had worse graft survival than those without DGF. Shortening the time on dialysis seems to be a modifiable factor to reduce DGF.

213.8: Systematic Use of Magnetic Double J Stent in Paediatric Kidney Transplantation: A Single Centre Experience

213.8: Systematic Use of Magnetic Double J Stent in Paediatric Kidney Transplantation: A Single Centre Experience