title: Across all solid organs, adolescent age recipients have worse transplant organ survival than younger age children: A US national registry analysis.
abstract: Univariate analyses suggest that adolescents have worse long-term allograft survival versus younger children across different SOT. This study's objective was to determine whether multivariate analyses of a large national database recording all deceased SOT (KI; LI; HR; LU) also show worse adolescent allograft survival in the different organs. Using data from the national Scientific Registry for Transplant Recipients in the USA for pediatric primary SOT from 1989 to 2010, we calculated median half-lives and constructed K-M graft survival curves. Recipient age at transplant (<12 or adolescent 12-17 yr) was fitted with other identical covariates into multivariate Cox proportional hazards models. In all SOT recipients, unadjusted graft survival curves demonstrated better graft survival for adolescents initially, followed by crossing of the lines, such that adolescent SOT recipients had worse survival after one yr (KI), 4.6 yr (LI), 4.4 yr (HR), and 1.6 yr (LU). Multivariate models of the post-cross period showed a significantly higher AHR for worse graft survival in adolescent age across all four SOTs: AHR 1.400 (KI), 1.958 (LI), 1.414 (HR), and 1.576 (LU). Improving adolescent long-term outcomes across all four organs will be a defining issue in the future.
authors.affiliation: University of Florida College of Medicine, Gainesville, FL, USA.|Washington University School of Medicine, St. Louis, MO, USA.
authors.forename: Vikas R
authors.initials: VR
authors.lastname: Dharnidharka
authors.affiliation: University of Florida College of Medicine, Gainesville, FL, USA.
authors.forename: Kenneth E
authors.initials: KE
authors.lastname: Lamb
authors.affiliation: Washington University School of Medicine, St. Louis, MO, USA.
authors.forename: Jie
authors.initials: J
authors.lastname: Zheng
authors.affiliation: Washington University School of Medicine, St. Louis, MO, USA.
authors.forename: Kenneth B
authors.initials: KB
authors.lastname: Schechtman
authors.affiliation: University of Florida College of Medicine, Gainesville, FL, USA.
authors.forename: Herwig-Ulf
authors.initials: HU
authors.lastname: Meier-Kriesche
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American; D000367:Age Factors; D064591:Allografts; D002648:Child; D005260:Female; D006085:Graft Survival; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016377:Organ Transplantation / Q000401:mortality*; D016016:Proportional Hazards Models; D012042:Registries; D016896:Treatment Outcome; D014481:United States
keywords: adolescents; heart; kidney; liver; lung; transplant