Faculty Collaboration Database

Loss of pediatric kidney grafts during the "high-risk age window": insights from pediatric liver and simultaneous liver-kidney recipients. Am J Transplant 2015 Feb;15(2):445-52

Date

01/24/2015

Pubmed ID

25612497

Pubmed Central ID

PMC4327777

DOI

10.1111/ajt.12985

Scopus ID

2-s2.0-84921476329 (requires institutional sign-in at Scopus site)   28 Citations

Abstract

Pediatric kidney transplant recipients experience a high-risk age window of increased graft loss during late adolescence and early adulthood that has been attributed primarily to sociobehavioral mechanisms such as nonadherence. An examination of how this age window affects recipients of other organs may inform the extent to which sociobehavioral mechanisms are to blame or whether kidney-specific biologic mechanisms may also exist. Graft loss risk across current recipient age was compared between pediatric kidney (n = 17,446), liver (n = 12,161) and simultaneous liver-kidney (n = 224) transplants using piecewise-constant hazard rate models. Kidney graft loss during late adolescence and early adulthood (ages 17-24 years) was significantly greater than during ages <17 (aHR = 1.79, 95%CI = 1.69-1.90, p < 0.001) and ages >24 (aHR = 1.11, 95%CI = 1.03-1.20, p = 0.005). In contrast, liver graft loss during ages 17-24 was no different than during ages <17 (aHR = 1.03, 95%CI = 0.92-1.16, p = 0.6) or ages >24 (aHR = 1.18, 95%CI = 0.98-1.42, p = 0.1). In simultaneous liver-kidney recipients, a trend towards increased kidney compared to liver graft loss was observed during ages 17-24 years. Late adolescence and early adulthood are less detrimental to pediatric liver grafts compared to kidney grafts, suggesting that sociobehavioral mechanisms alone may be insufficient to create the high-risk age window and that additional biologic mechanisms may also be required.

Author List

Van Arendonk KJ, King EA, Orandi BJ, James NT, Smith JM, Colombani PM, Magee JC, Segev DL

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

Adolescent
Age Factors
Child
Child, Preschool
Female
Graft Rejection
Humans
Incidence
Infant
Kidney Transplantation
Liver Transplantation
Male
Registries
Retrospective Studies
Risk Assessment
Transplant Recipients
Young Adult