title: Risk factors for chronic rejection in pediatric renal allograft recipients.
abstract: To determine the risk factors predictive of graft loss from chronic rejection in pediatric renal allograft recipients, we reviewed the collaborative study database of the Société de Néphrologie Pédiatrique which registered 314 grafts from January 1987 to December 1991. Of the 289 grafts analyzed, 71 failed during follow-up, chronic rejection being the most common cause of graft loss (35%). The clinical features of the chronic rejection group (n = 25) were compared with those of the group without failure (n = 218). The variables tested by monovariate analysis were cyclosporine dose at 1 year, donor type, donor and recipient age, and acute rejection episodes. The incidence of graft loss due to chronic rejection was 4% (4/109) in patients who had no acute rejection and 16% (21/134) in those with at least one acute rejection episode (P = 0.002). Donor age (< or = 5 years) was a risk factor for chronic rejection (P = 0.024). Recipient age and donor type were not significantly different between the chronic rejection group and the control group. Using time-dependent covariates, the risk factors were an acute rejection episode (P = 0.003) and low cyclosporine doses at 1 year (P = 0.02). We conclude that acute rejection and low cyclosporine doses in these pediatric patients were risk factors for graft loss due to chronic rejection.
authors.affiliation: Centre Hôspitalier Régional, Nantes, France.
authors.forename: C
authors.initials: C
authors.lastname: Guyot
authors.forename: J M
authors.initials: JM
authors.lastname: Nguyen
authors.forename: P
authors.initials: P
authors.lastname: Cochat
authors.forename: M
authors.initials: M
authors.lastname: Foulard
authors.forename: F
authors.initials: F
authors.lastname: Bouissou
authors.forename: R
authors.initials: R
authors.lastname: Van Damme-Lombaerts
authors.forename: C
authors.initials: C
authors.lastname: Loirat
authors.forename: F
authors.initials: F
authors.lastname: Janssen
authors.forename: A
authors.initials: A
authors.lastname: Bensman
authors.forename: H
authors.initials: H
authors.lastname: Nivet
authors.forename: M
authors.initials: M
authors.lastname: Fischbach
authors.forename: J P
authors.initials: JP
authors.lastname: Guignard
authors.forename: J L
authors.initials: JL
authors.lastname: André
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D003195:Computer Communication Networks; D016572:Cyclosporine / Q000627:therapeutic use; D005260:Female; D006084:Graft Rejection / Q000188:drug therapy / Q000503:physiopathology*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000502:physiology*; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D014019:Tissue Donors; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D016572:Cyclosporine