title: Long-term outcome of pediatric renal transplantation: a single center study in Japan.
abstract: Little is known about the risk factors for long-term poor outcome in pediatric renal transplantation. Between 1973 and 2010, 111 renal transplants (92 living donations) were performed in 104 children (56 males, mean age, 12.5 yr) at the Social Insurance Chukyo Hospital, and followed-up for a mean period of 13.6 yr. The patient survival at 1, 5, 10, 15, 20 (living- and deceased-donor transplants), and 30 yr (living-donor transplants only) was 98.1%, 92.8%, 87.8%, 84.9%, 82.6%, and 79.3%. The graft survival at 1, 5, 10, 15, 20, and 30 yr was 92.0%, 77.3%, 58.4%, 50.8%, 38.5%, and 33.3%. The most common cause of graft loss was CAI, AR, death with functioning, recurrent primary disease, ATN, and malignancy. Donor gender, ATN, malignancy/cardiovascular events, and eras affected patient survival. AR and CAI were the risk factors for graft loss. The evolved immunosuppression protocols improved the outcome by reducing AR episodes and ATN but not CAI, suggesting CAI as the major risk factor for graft loss. CAI was correlated with AR episodes, CMV infection, and post-transplant hypertension. Strategies for preventing the risk factors for malignancy/cardiovascular events and CAI, including hypertension/infection, are crucial for better outcomes.
authors.affiliation: Department of Pediatrics, Social Insurance Chukyo Hospital, Nagoya, Aichi, Japan.
authors.forename: Akio
authors.initials: A
authors.lastname: Yamada
authors.forename: Atsushi
authors.initials: A
authors.lastname: Tashiro
authors.forename: Tomoko
authors.initials: T
authors.lastname: Hiraiwa
authors.forename: Tomonori
authors.initials: T
authors.lastname: Komatsu
authors.forename: Tsuneo
authors.initials: T
authors.lastname: Kinukawa
authors.forename: Norishi
authors.initials: N
authors.lastname: Ueda
mesh_terms: D000293:Adolescent; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000209:etiology; D006085:Graft Survival; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects* / Q000379:methods*; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007239:Infections / Q000150:complications; D007564:Japan; D007676:Kidney Failure, Chronic / Q000401:mortality / Q000628:therapy*; D016030:Kidney Transplantation; D019520:Living Donors; D008297:Male; D009369:Neoplasms / Q000150:complications; D010372:Pediatrics; D011183:Postoperative Complications; D012307:Risk Factors; D012737:Sex Factors; D014019:Tissue Donors; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents
keywords: cardiovascular events; gender; hypertension; immunosuppression; malignancy; rejection