title: Outcome differences between young children and adolescents undergoing kidney transplantation.
abstract: OBJECTIVE
  Although graft loss remains the biggest challenge for all pediatric kidney transplant (KT) recipients, unique challenges exist within different age groups. We aim to evaluate the different characteristics and graft survival outcomes of young children and adolescents undergoing KT.
  
  
  METHODS
  Children who underwent isolated KT between 2000 and 2013 at our institution were included in this retrospective analysis. Patient characteristics and outcomes were compared using student's t-test, chi-square test, Kaplan-Meier curve and Cox proportional hazards model.
  
  
  RESULTS
  Of 73 children who underwent KT, 31 were <12 (young children), and 42 were ≥ 12 years old (adolescents). Overall patient survival was 100%. The younger group had superior 5-year (100% vs. 75.5%) and 10-year (94.4% vs. 43.8%) graft survival (p=0.008). Factors predictive of poor graft survival on multivariate analysis were older age at transplantation (HR 1.2, CI 1-1.4, p=0.047), female gender (HR 9.0, CI 1.9-43, p=0.006), and acute rejection episodes (HR 13, CI 2-90, p=0.008). The most common causes of graft loss were acute and chronic rejection episodes and immunosuppression nonadherence.
  
  
  CONCLUSIONS
  Adolescents undergoing KT have inferior graft survival compared to younger children. In adjusted modeling, children with older age, female gender, and acute rejection episodes have inferior graft survival.
authors: Department of Surgery, Case Western Reserve University & University Hospitals Rainbow Babies & Children's Hospital, Cleveland, OH.
authors: Iuliana D
authors: ID
authors: Bobanga
authors: Departments of Pediatrics, Case Western Reserve University & University Hospitals Rainbow Babies & Children's Hospital, Cleveland, OH.
authors: Beth A
authors: BA
authors: Vogt
authors: Department of Surgery, Case Western Reserve University & University Hospitals Rainbow Babies & Children's Hospital, Cleveland, OH. Electronic address: woodside@umich.edu.
authors: Kenneth J
authors: KJ
authors: Woodside
authors: Department of Surgery, Case Western Reserve University & University Hospitals Rainbow Babies & Children's Hospital, Cleveland, OH.
authors: Devan R
authors: DR
authors: Cote
authors: Departments of Pediatrics, Case Western Reserve University & University Hospitals Rainbow Babies & Children's Hospital, Cleveland, OH.
authors: Katherine M
authors: KM
authors: Dell
authors: Departments of Pediatrics, Case Western Reserve University & University Hospitals Rainbow Babies & Children's Hospital, Cleveland, OH.
authors: Robert J
authors: RJ
authors: Cunningham
authors: Department of Surgery, Case Western Reserve University & University Hospitals Rainbow Babies & Children's Hospital, Cleveland, OH.
authors: Kelly A
authors: KA
authors: Noon
authors: Department of Surgery, Case Western Reserve University & University Hospitals Rainbow Babies & Children's Hospital, Cleveland, OH.
authors: Edward M
authors: EM
authors: Barksdale
authors: Department of Surgery, Case Western Reserve University & University Hospitals Rainbow Babies & Children's Hospital, Cleveland, OH.
authors: Vanessa R
authors: VR
authors: Humphreville
authors: Department of Surgery, Case Western Reserve University & University Hospitals Rainbow Babies & Children's Hospital, Cleveland, OH.
authors: Edmund Q
authors: EQ
authors: Sanchez
authors: Department of Surgery, Case Western Reserve University & University Hospitals Rainbow Babies & Children's Hospital, Cleveland, OH.
authors: James A
authors: JA
authors: Schulak
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology / Q000209:etiology; D006085:Graft Survival; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D053208:Kaplan-Meier Estimate; D016030:Kidney Transplantation / Q000401:mortality; D008297:Male; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012737:Sex Factors
keywords: Adolescence; Graft survival; Kidney transplantation; Pediatric; Rejection