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Acute rejection in pediatric renal transplantation: Retrospective study of epidemiology, risk factors, and impact on renal function
Author(s) -
Nascimento Ghizoni Pereira Luiza,
TedescoSilva Hélio,
KochNogueira Paulo Cesar
Publication year - 2021
Publication title -
pediatric transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.457
H-Index - 69
eISSN - 1399-3046
pISSN - 1397-3142
DOI - 10.1111/petr.13856
Subject(s) - medicine , cumulative incidence , incidence (geometry) , retrospective cohort study , transplantation , kidney transplantation , renal function , cohort , cohort study , surgery , physics , optics
AR is a major relevant and challenging topic in pediatric kidney transplantation. Our objective was to evaluate cumulative incidence of AR in pediatric kidney transplant patient, risk factors for this outcome, and impact on allograft function and survival. A retrospective cohort including pediatric patients that underwent kidney transplantation between 2011 and 2015 was designed. Risk factors for AR were tested by competing risk analysis. To estimate its impact, graft survival and difference in GFR were evaluated. Two hundred thirty patients were included. As a whole, the incidence of AR episodes was 0.16 (95% CI = 0.12‐0.20) per person‐year of follow‐up. And cumulative incidence of AR was 23% in 1 year and 39% in 5 years. Risk factors for AR were number of MM (SHR 1.36 CI 1.14‐1.63 P = .001); ISS with CSA, PRED, and AZA (SHR 2.22 CI 1.14‐4.33 P = .018); DGF (SHR 2.49 CI 1.57‐3.93 P < .001); CMV infection (SHR 5.52 CI 2.27‐11.0 P < .001); and poor adherence (SHR 2.28 CI 1.70‐4.66 P < .001). Death‐censored graft survival in 1 and 5 years was 92.5% and 72.1%. Risk factors for graft loss were number of MM (HR 1.51 CI 1.07‐2.13 P = .01), >12 years (HR 2.66 CI 1.07‐6.59 P = .03), and PRA 1%‐50% (HR 2.67 CI 1.24‐5.73 P = .01). Although occurrence of AR did not influence 5‐year graft survival, it negatively impacted GFR. AR was frequent in patients assessed and associated with number of MM, ISS regimen, DGF, CMV infection, and poor adherence, and had deleterious effect on GFR.