Pediatric kidney transplantation: early and long-term outcomes following 1187 procedures

Abstract

Aim — to estimate short- and long-term outcomes of pediatric kidney transplants in Russia considering the maximum available number of cases. Material and methods. Retrospective, observational, multi-center study included data about 1187 kidney transplantation procedures (866 — deceased donor, 281 — living donor and 40 — AB0-incompatible living donor) performed in 1065 patients (age 0—17 years) since 1990 till 2017. Patient and graft survival, causes of recipient deaths and graft losses, as well as, the influence of donor type, blood group incompatibility and recipient age on outcomes were analyzed. Results of redo transplantations (n=131) were also investigated. Results. Annual, 5-, 10-, and 15-year survival of patient was 94, 86, 79 and 69%, respectively; graft survival — 85, 67, 53 and 33%, respectively. Transplantation from related donors including AB0-incompatible cases was associated with 15—30% increase of graft survival (p<0.0001). Up to 23% of children required redo transplantation within 4—5 years after primary procedure and 2/3 of patients — after 10–15 years. There were no significant differences in outcomes after primary and redo procedures: annual, 5-, 10- and 15-year graft survival was 85, 68, 55, 42 and 85, 62, 45, 19%, respectively (p=0.1164). Conclusion. It is reasonable to consider the outcomes of transplantations as satisfactory in Russia. However, there is a great potential for improvement. The main problems are high incidence of infectious complications followed by fatal outcomes (41% of all fatal outcomes) and loss of allograft due to primary dysfunction and death of recipients with functioning allografts (19 and 23%, respectively). Primary use of living-related donors for pediatric kidney transplantation seems to be the most effective way to improve both short- and long-term outcomes.