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. 2023 Nov 9;12(22):7014.
doi: 10.3390/jcm12227014.

Risk Factor Analysis for Long-Term Graft Survival Following Pediatric Kidney Transplantation: The Importance of Pretransplantation Time on Dialysis and Donor/Recipient Age Difference

Marios Marcou  1   2 , Matthias Galiano  3   2 , Anja Tzschoppe  3   2 , Katja Sauerstein  3   2 , Sven Wach  1   2 , Helge Taubert  1   2 , Bernd Wullich  1   2 , Karin Hirsch-Koch  1   2 , Hendrik Apel  1   2
Affiliations

Risk Factor Analysis for Long-Term Graft Survival Following Pediatric Kidney Transplantation: The Importance of Pretransplantation Time on Dialysis and Donor/Recipient Age Difference

Marios Marcou et al. J Clin Med. .

Abstract

Recognizing risk factors that may negatively affect long-term graft survival following pediatric kidney transplantation is a key element in the decision-making process during organ allocation. We retrospectively reassessed all cases of pediatric kidney transplantation performed in our center in the last 20 years with the aim of determining baseline characteristics that could be identified as prognostic risk factors for long-term graft survival. Between 2001 and 2020, a total of 91 kidney transplantations in children under the age of 18 years were undertaken in our center. Early graft failure was observed in six of the 91 patients (7%). The median follow-up of the remaining 85 children was 100 months, and the overall kidney graft survival rates at 5, 10, 15 and 20 years were 85.2%, 71.4%, 46.0% and 30.6%, respectively. Small children with a body surface area of <1 m2 were significantly associated with better long-term graft survival outcomes, while adolescents aged more than twelve years showed poorer graft survival rates than younger children. Body surface area of the recipient of ≥1 m2, pretransplantation duration of the recipient on dialysis ≥18 months, hemodialysis prior to transplantation and donor/recipient age difference of ≥25 years were significantly associated with poorer long-term graft survival.

Keywords: age difference; children; graft survival; kidney transplantation; renal dialysis.

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Conflict of interest statement

The authors declare that they have no conflict of interest or financial ties to disclose.

Figures

Figure 1
Figure 1
Kaplan–Meier survival analysis: association of age difference between donor and recipient with long-term survival of kidney graft. A univariate log-rank analysis shows a significant association between a large age difference between donor and recipient (≥25 years) and a shorter survival time of the kidney graft compared to patients with a smaller age difference <25 years (p = 0.04). Graft loss of pediatric recipients with a donor/recipient age difference of ≥25 years appeared after a median duration of approximately six years (IQR 57–136 months), and long-term graft survival of these patients at five, ten, fifteen and twenty years was 85.3%, 65.9%, 31.7% and 31.7%, respectively, compared to 95.5%, 80.3%, 74.1% and 37.0% of recipients with a donor/recipient age difference of <25 years.
Figure 2
Figure 2
Kaplan–Meier analysis: association of duration of pretransplantation time of dialysis with long-term survival of kidney graft. A univariate log-rank analysis showed a significant association between a longer pretransplantation duration of dialysis (≥18 months) and a shorter survival time of the kidney graft compared to patients with a shorter pretransplantation duration of dialysis (<18 months; p = 0.02).
Figure 3
Figure 3
Kaplan–Meier analysis: association of the modality of dialysis undergone by the recipients preceding the kidney transplantation with long-term survival of kidney graft. A univariate log-rank analysis showed a significant association between hemodialysis and a poorer kidney graft survival rate (p < 0.01).
Figure 4
Figure 4
Kaplan–Meier analysis: association of body surface area (BSA) with long-term survival of kidney graft. A univariate log-rank analysis showed a significant association between a smaller BSA (<1 m2) and a longer survival time of the kidney graft (p < 0.01).
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