Determinants of Late Acute Rejection in Pediatric & Adolescent Kidney Transplant Recipients
Loai A. Eid1, Shamir Tuchman1, Asha Moudgil1
1. Nephrology, Children's National Medical Center, Washington, DC, United States.
Purpose of Study: Long-term graft function has not kept pace with short-term graft survival in children. Late Acute Rejection (LAR) episodes are in part responsible for the lack of long-term graft survival. The risk factors for LAR in pediatric & adolescent in kidney transplant (Tx) recipients are not well defined.
Methods Used: A retrospective analysis of pediatric & adolescent kidney Tx recipients ?21 yrs of age at the time of Tx with at least 1 yr follow-up. Of 73 Tx recipients, 64 were included in the analysis. 9 recipients were excluded for either graft loss or early acute rejection (occurring ?6 months post-Tx). The included patients were divided into 2 cohorts; control group-41 & LAR group-23 patients (?6 months at time of rejection). Donor-Specific Antibodies (DSA) were obtained at the time of clinical suspicion of LAR.
Summary of Results: LAR was diagnosed by clinical & histological criteria in 23 (35.9%) Tx recipients. Mean age at the time of LAR was 14.7±4.8 yrs with 60.8% ?12 yrs of age. Mean follow-up period was 31.2 (3.9-79) months. Significant clinical & demographic factors that were associated with LAR by univariate analyses in the cohort are shown below in table1. Other variables with p<0.10 in univariate analyses were included in multivariate logistic-regression analyses with the odds ratio of each variable shown below in table2.
Conclusions: Development of de-novo DSA, DGF, & increased variability of TAC levels are risk factors for LAR in pediatric & adolescent. The effect of non-adherence on LAR couldn't be demonstrated in multivariate analyses. These results need to be validated through a prospective multi-center study.
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