title: Factors associated with patient and graft survival using kidneys from cadaveric donors in transplant patients under 18 years of age in Argentina.
abstract: BACKGROUND
  Thanks to advances in surgical techniques and immune system suppression, the mortality rate in children with end-stage renal disease (ESRD) has dramatically declined. Kidney transplantation has become the primary method to treat ESRD in the pediatric population.
  
  
  METHODS
  Information was obtained from SINTRA (National Information System of Orrgan Procurement and transplantation in Argentina) for the period 1998-2009. We used the Kaplan-Meier curve, survival was measured at 30 days, 1, 5, and 10 years. The Cox regression variables taken for patient and graft survival were gender and age of both donor and recipient, ischemia time (> or <24 hr), etiology of chronic renal failure, time on dialysis (> or <3 years) of the recipient, cause of donor's death (stroke, head trauma, anoxia, other causes of coma, tumor and others). We coded the value of mismatch. For each HLA, it was 0 when they shared the 2. Adding the 3 types of antigens, the possible mismatch values ranged between 0 and 6. However, all had values between 5 and 6. We used SPSS statistical software Medcalc 17.
  
  
  RESULTS
  We analyzed 345 (54%) men and 290 (46%) women. The average age was 12.5 + 3.9 years. The median follow-up time was 4 years (maximum 13 years). Patient survival rates at 30 days were 99.4%, at 1 year 96.8%, at 5 years 91.1%, and at 10 years 82.5%. Cox regression for patient survival: being a female and receiving HR 1.88 (95% CI 1.09-3.25) P = .023 or donor HR 1.86 (95% CI 1.06-3.25) P = .030. Tumor HR 17.19 (95% CI 4.48-65.98) P = <.0001. For recipient's age compared with <12 years >12 years HR 1.99 (95% CI 1.11-3.65) P = <.024. Graft survival rate at 30 days was 97.2%, at 1 year was 91.9%, at 5 years was 79.3% and at 10 years was 61.8%. Compared with donor's age <18 years: 45-59 years HR 2.52 (95% CI 1.42-4.47) P = .002. Glomerulonephritis HR 1.71 (95% CI 1.10-2.77) P = .018. Tumor as the cause of donor's death HR 4.39 (95% CI 1.28-2.28) P = .012. Time on dialysis > 3 years HR 1.59 (95% CI 1.11-2.28) P = .012.
  
  
  CONCLUSIONS
  Being a female, receiving a kidney from a woman and tumor as the cause of donor's death and age >12 years were associated with worse patient survival. Donor's age between 45 and 59, glomerulonephritis as the etiology of renal failure, tumor as the cause of death and time on dialysis >3 years were associated with lower graft survival.
authors.affiliation: Scientific-Technical Office at INCUCAI (National Institute of Procurement and transplantation in Argentina-Ministry of Health), Buenos Aires, Argentina. ibisigniano@incucai.gov.ar
authors.forename: L
authors.initials: L
authors.lastname: Bisigniano
authors.forename: A
authors.initials: A
authors.lastname: López-Rivera
authors.forename: V
authors.initials: V
authors.lastname: Tagliafichi
authors.forename: V
authors.initials: V
authors.lastname: Fernández
authors.forename: C
authors.initials: C
authors.lastname: Soratti
mesh_terms: D000293:Adolescent; D001118:Argentina; D002102:Cadaver; D002648:Child; D005260:Female; D006085:Graft Survival; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D015996:Survival Rate; D014019:Tissue Donors