title: Rejection is a strong graft survival predictor in live donor pediatric renal transplantation using cyclosporine, mycophenolate mofetil, and steroids: 5-year outcomes in a single Mexican center.
abstract: Long-term graft function and survival are of particular importance in children assuming that they have a longer transplantation life span than most adults. Because acute rejection episodes (ARE) continue to have a serious impact on graft loss, we analyzed the effects of ARE on 5-year survival and function in our population. Fifty-seven living donor kidney transplant recipients (34 males) younger than 18 years of age (13.5 ± 2.6 years; range, 5-17) were follow up for at feast 12 months using cyclosporine, mycophenolate mofetil, and steroid therapy with or without induction treatment between February 2003 and December 2010. ARE incidence during the first 12 months following transplantation was 14%. One-, 3- and 5-year serum creatinine values were 1.24 ± 0.39, 2.16 ± 2.39, and 1.76 ± 0.9 mg/dL, respectively. Mean calculated creatinine clearances (Schwartz) at 1, 3, and 5 years were 82.5 ± 24.8, 64.7 ± 24.1, and 67 ± 27.5 mL/min*1.73 m(2), respectively. Patient/graft survival rates were 96/85%, 90/72%, and 88/65% at 1, 3, and 5 years, respectively. Patients who experienced an ARE within 12 months following transplantation displayed a reduced 5-year graft survival rate (37.5%) versus those who did not (78%; P = .005). Patients who did not have an ARE during 60 months had a higher graft survival rate (76%) than those who had ARE (33%; P = .001). Patient without basiliximab induction showed a lower 5-year graft survival rate (61% vs 100%; P = not significant [NS]). ARE is an important risk factor for graft loss in the pediatric kidney transplant population.
authors.affiliation: Organ Transplantation, Instituto Mexicano del Seguro Social, Unidad Medica de Alta Especialidad 189 ARC Veracruz, Nefrologia y Trasplantes de Veracruz, Veracruz, Mexico. gmtzmier@hotmail.com
authors.forename: G
authors.initials: G
authors.lastname: Martinez-Mier
authors.forename: H
authors.initials: H
authors.lastname: Enriquez-De Los Santos
authors.forename: M T
authors.initials: MT
authors.lastname: Méndez-López
authors.forename: S F
authors.initials: SF
authors.lastname: Avila-Pardo
authors.forename: L F
authors.initials: LF
authors.lastname: Budar-Fernandez
authors.forename: F
authors.initials: F
authors.lastname: Gonzalez-Velazquez
mesh_terms: D000293:Adolescent; D002648:Child; D016572:Cyclosporine / Q000008:administration & dosage*; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D016030:Kidney Transplantation; D019520:Living Donors; D008297:Male; D008800:Mexico; D009173:Mycophenolic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives*; D013256:Steroids / Q000008:administration & dosage*
chemical_list: D007166:Immunosuppressive Agents; D013256:Steroids; D016572:Cyclosporine; D009173:Mycophenolic Acid