title: Age at graft loss after pediatric kidney transplantation: exploring the high-risk age window.
abstract: OBJECTIVE
  The risk of graft loss after pediatric kidney transplantation increases during late adolescence and early adulthood, but the extent to which this phenomenon affects all recipients is unknown. This study explored interactions between recipient factors and this high-risk age window, searching for a recipient phenotype that may be less susceptible during this detrimental age interval.
  
  
  METHODS
  With use of Scientific Registry of Transplant Recipients data from 1987 to 2010, risk of graft loss across recipient age was quantified using a multivariable piecewise-constant hazard rate model with time-varying coefficients for recipient risk factors.
  
  
  RESULTS
  Among 16,266 recipients, graft loss during ages ≥17 and <24 years was greater than that for both 3-17 years (adjusted hazard ratio [aHR], 1.61; P<0.001) and ≥24 years (aHR, 1.28; P<0.001). This finding was consistent across age at transplantation, sex, race, cause of renal disease, insurance type, pretransplant dialysis history, previous transplant, peak panel-reactive antibody (PRA), and type of induction immunosuppression. The high-risk window was seen in both living-donor and deceased-donor transplant recipients, at all levels of HLA mismatch, regardless of centers' pediatric transplant volume, and consistently over time. The relationship between graft loss risk and donor type, PRA, transplant history, insurance type, and cause of renal disease was diminished upon entry into the high-risk window.
  
  
  CONCLUSIONS
  No recipient subgroups are exempt from the dramatic increase in graft loss during late adolescence and early adulthood, a high-risk window that modifies the relationship between typical recipient risk factors and graft loss.
authors: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, USA.
authors: Kyle J
authors: KJ
authors: Van Arendonk
authors: Nathan T
authors: NT
authors: James
authors: Brian J
authors: BJ
authors: Boyarsky
authors: Jacqueline M
authors: JM
authors: Garonzik-Wang
authors: Babak J
authors: BJ
authors: Orandi
authors: John C
authors: JC
authors: Magee
authors: Jodi M
authors: JM
authors: Smith
authors: Paul M
authors: PM
authors: Colombani
authors: Dorry L
authors: DL
authors: Segev
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D005260:Female; D006085:Graft Survival; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D015233:Models, Statistical; D015999:Multivariate Analysis; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult