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Late first acute rejection in pediatric kidney transplantation: A North American Pediatric Renal Trials and Collaborative Studies special study. Pediatr Transplant 2021 Aug;25(5):e13953



Pubmed ID




Scopus ID

2-s2.0-85112490792 (requires institutional sign-in at Scopus site)   2 Citations


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.

Author List

Barton KT, Halani K, Galbiati S, Dandamudi R, Hmiel SP, Dharnidharka VR, NAPRTCS investigators


Cynthia G. Pan MD Adjunct Professor in the Pediatrics department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Child, Preschool
Donor Selection
Follow-Up Studies
Graft Rejection
Infant, Newborn
Kaplan-Meier Estimate
Kidney Transplantation
Linear Models
North America
Proportional Hazards Models
Retrospective Studies
Risk Factors
Time Factors