Late first acute rejection in pediatric kidney transplantation: A North American Pediatric Renal Trials and Collaborative Studies special study

Kevin T Barton; Khalif Halani; Shirley Galbiati; Raja Dandamudi; Stanley Paul Hmiel; Vikas R Dharnidharka; NAPRTCS investigators

doi:10.1111/petr.13953

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Late first acute rejection in pediatric kidney transplantation: A North American Pediatric Renal Trials and Collaborative Studies special study

Journal article

Peer reviewed

Late first acute rejection in pediatric kidney transplantation: A North American Pediatric Renal Trials and Collaborative Studies special study

Kevin T Barton, Khalif Halani, Shirley Galbiati, Raja Dandamudi, Stanley Paul Hmiel, Vikas R Dharnidharka and NAPRTCS investigators

Pediatric transplantation, Vol.25(5), p.e13953

08/2021

DOI: 10.1111/petr.13953

PMID: 33350558

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Abstract

Rates of early AR in pediatric kidney transplantation have declined in every era but the most recent NAPRTCS cohort has shown an increase in late first AR rates. We hypothesized this was due to an increased proportion of deceased donor utilization and early steroid taper utilization. Using the NAPRTCS database, we compared the most recent three cohorts of patients transplanted between 2002-2006, 2007-2011, and 2012-2017. To determine variables that predict late first AR, we used two multivariable models: a standard Cox regression model and LASSO model. From the LASSO model, deceased donor source (P = .002), higher recipient age (P = .019), black race (P = .010), and transplant cohort 2012-17 (P = .014) were all significant predictors of more late first AR. On standard Cox regression analysis, those same variables, minus donor source, were significant, in addition to mycophenolates usage (P = .007) and lower eGFR at 12 months (P = .02). The most recent 2012-2017 cohort remains an independently significant risk factor for late first AR, suggesting unmeasured variables. Further research is needed to determine whether these higher late first AR rates will impact long-term graft survival in the most recent cohort.

North America

Adolescent

Child

Child, Preschool

Donor Selection - methods

Donor Selection - trends

Female

Follow-Up Studies

Graft Rejection - epidemiology

Graft Rejection - etiology

Humans

Infant

Infant, Newborn

Kaplan-Meier Estimate

Kidney Transplantation

Linear Models

Male

Proportional Hazards Models

Retrospective Studies

Risk Factors

Time Factors

Details

Title: Subtitle: Late first acute rejection in pediatric kidney transplantation: A North American Pediatric Renal Trials and Collaborative Studies special study
Creators: Kevin T Barton - St. Louis Children's Hospital
Khalif Halani - Emmes
Shirley Galbiati - Emmes
Raja Dandamudi - St. Louis Children's Hospital
Stanley Paul Hmiel - St. Louis Children's Hospital
Vikas R Dharnidharka - St. Louis Children's Hospital
NAPRTCS investigators
Contributors: Kathy K Lee-Son (Contributor) - University of Iowa, Nephrology, Dialysis and Transplantation
Resource Type: Journal article
Publication Details: Pediatric transplantation, Vol.25(5), p.e13953
DOI: 10.1111/petr.13953
PMID: 33350558
ISSN: 1397-3142
eISSN: 1399-3046
Language: English
Date published: 08/2021
Academic Unit: Nephrology, Dialysis and Transplantation; Stead Family Department of Pediatrics
Record Identifier: 9984353843802771

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5 Times Cited - Web of Science

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