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Kidney transplant survival in pediatric and young adults.

Kiberd JA, Acott P, Kiberd BA - BMC Nephrol (2011)

Bottom Line: The perception that pediatric transfers do poorly reflects advanced graft dysfunction in some at the time of transfer.The evidence also suggests that it is not the transfer of care that is the critical issue but rather recipients, somewhere between the ages of 11-14 and 25, are a unique and vulnerable cohort.Effective strategies to improve outcomes across this age group need to be identified and applied consistently.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Medicine and Pediatrics, Dalhousie Medical School, Halifax, Nova Scotia, Canada.

ABSTRACT

Background: There is a perception that kidney transplant recipients transferred from pediatric centers to adult care have an increased risk of graft loss. It is not clear whether young adults transplanted in adult centers also suffer from high graft loss rates.

Methods: We examined death censored graft survival in 3 cohorts of young patients transplanted at a single center. Pediatric (PED) patients transplanted at the pediatric center were compared to a cohort of young adults (YAD; age 18- < 25) and a cohort of adults (ADL; age 25-35).

Results: In a multivariate Cox model for death-censored graft survival, PED survival was statistically similar to the YAD (HR 0.86, 95% CI 0.44, 1.7, p = 0.66), however the ADL cohort (HR 0.45, 95% CI 0.25, 0.82, p = 0.009) demonstrated better survival. Admitted non-adherence rates were not different among cohorts. Patients were transferred within a narrow age window (18.6 ± 1.0 age in years) but at a wide range of times from the date of transplantation (5.1 ± 3.5 years) and with a wide range of graft function (serum creatinine 182 ± 81 μmol/L).

Conclusions: The perception that pediatric transfers do poorly reflects advanced graft dysfunction in some at the time of transfer. The evidence also suggests that it is not the transfer of care that is the critical issue but rather recipients, somewhere between the ages of 11-14 and 25, are a unique and vulnerable cohort. Effective strategies to improve outcomes across this age group need to be identified and applied consistently.

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Death Censored Graft Survival (Kaplan-Meier) after year 1 and stratified by Age Group (PED, Pediatric; YAD, Young Adult age < 25; ADL, Adult age 25-35).
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Figure 1: Death Censored Graft Survival (Kaplan-Meier) after year 1 and stratified by Age Group (PED, Pediatric; YAD, Young Adult age < 25; ADL, Adult age 25-35).

Mentions: Twenty six transplants were lost within 1 year (PED- 7 (12.5%); YAD-6 (11.1%); ADL-13 (9.5%)) and these graft outcomes were excluded. All 7 of the pediatric graft losses occurred at the pediatric center. The remaining were distributed to the PED (n = 49), YAD (n = 48) and ADL (n = 124) cohorts. Figure 1 shows the Kaplan-Meier death censored graft survival for the 3 age cohorts. The survival for the first 2 cohorts (PED and YAD) are almost superimposed where as the graft survival is statistically better (p = 0.04) in the oldest age cohort (ADL; age 25-35). There were 17 patients that died with a functioning graft (PED-2; YAD-2; ADL-13)


Kidney transplant survival in pediatric and young adults.

Kiberd JA, Acott P, Kiberd BA - BMC Nephrol (2011)

Death Censored Graft Survival (Kaplan-Meier) after year 1 and stratified by Age Group (PED, Pediatric; YAD, Young Adult age < 25; ADL, Adult age 25-35).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3198885&req=5

Figure 1: Death Censored Graft Survival (Kaplan-Meier) after year 1 and stratified by Age Group (PED, Pediatric; YAD, Young Adult age < 25; ADL, Adult age 25-35).
Mentions: Twenty six transplants were lost within 1 year (PED- 7 (12.5%); YAD-6 (11.1%); ADL-13 (9.5%)) and these graft outcomes were excluded. All 7 of the pediatric graft losses occurred at the pediatric center. The remaining were distributed to the PED (n = 49), YAD (n = 48) and ADL (n = 124) cohorts. Figure 1 shows the Kaplan-Meier death censored graft survival for the 3 age cohorts. The survival for the first 2 cohorts (PED and YAD) are almost superimposed where as the graft survival is statistically better (p = 0.04) in the oldest age cohort (ADL; age 25-35). There were 17 patients that died with a functioning graft (PED-2; YAD-2; ADL-13)

Bottom Line: The perception that pediatric transfers do poorly reflects advanced graft dysfunction in some at the time of transfer.The evidence also suggests that it is not the transfer of care that is the critical issue but rather recipients, somewhere between the ages of 11-14 and 25, are a unique and vulnerable cohort.Effective strategies to improve outcomes across this age group need to be identified and applied consistently.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Medicine and Pediatrics, Dalhousie Medical School, Halifax, Nova Scotia, Canada.

ABSTRACT

Background: There is a perception that kidney transplant recipients transferred from pediatric centers to adult care have an increased risk of graft loss. It is not clear whether young adults transplanted in adult centers also suffer from high graft loss rates.

Methods: We examined death censored graft survival in 3 cohorts of young patients transplanted at a single center. Pediatric (PED) patients transplanted at the pediatric center were compared to a cohort of young adults (YAD; age 18- < 25) and a cohort of adults (ADL; age 25-35).

Results: In a multivariate Cox model for death-censored graft survival, PED survival was statistically similar to the YAD (HR 0.86, 95% CI 0.44, 1.7, p = 0.66), however the ADL cohort (HR 0.45, 95% CI 0.25, 0.82, p = 0.009) demonstrated better survival. Admitted non-adherence rates were not different among cohorts. Patients were transferred within a narrow age window (18.6 ± 1.0 age in years) but at a wide range of times from the date of transplantation (5.1 ± 3.5 years) and with a wide range of graft function (serum creatinine 182 ± 81 μmol/L).

Conclusions: The perception that pediatric transfers do poorly reflects advanced graft dysfunction in some at the time of transfer. The evidence also suggests that it is not the transfer of care that is the critical issue but rather recipients, somewhere between the ages of 11-14 and 25, are a unique and vulnerable cohort. Effective strategies to improve outcomes across this age group need to be identified and applied consistently.

Show MeSH
Related in: MedlinePlus