title: Outcomes and Risk Factors for Graft Loss: Lessons Learned from 1,056 Pediatric Kidney Transplants at the University of Minnesota.
abstract: BACKGROUND
  Advances in immunosuppression, surgical techniques, and management of infections in children receiving kidney transplants have affected outcomes.
  
  
  METHODS
  We analyzed a prospectively maintained database of pediatric kidney transplantations.
  
  
  RESULTS
  From June 1963 through October 2016, we performed 1,056 pediatric kidney transplantations. Of these, 129 were in children less than 2 years old. The most common indications for transplant were congenital anomalies (dysplastic kidneys), obstructive uropathy, and congenital nephrotic syndrome. Living donors constituted 721 (68%) of all donors. The graft and patient survival rates remarkably improved for both deceased and living donor recipients (p = 0.001). Currently, graft survival rates for deceased donor recipients are 92% at 1 year, 76% at 5 years, and 57% at 10 years post-transplant; for living donor recipients, 96% at 1 year, 85% at 5 years, and 78% at 10 years. The graft half-life was 19 years in deceased donor recipients, compared with 25 years in living donor recipients (p ≤ 0.001). Acute rejection was the most common cause of graft loss in the first year post-transplant. The following risk factors were associated with an increased risk of graft loss: deceased donor grafts (p = 0.0001), retransplant (p = 0.02), ages 11 to 18 years (p = 0.001) and pre-transplant urologic issues (p = 0.04). Living donor grafts (p ≤ 0.0001) and pre-emptive transplants (p = 0.02) were associated with decreased risks of graft loss.
  
  
  CONCLUSIONS
  The success rates of pediatric kidney transplants have significantly improved. Pre-emptive kidney transplantation with a living donor graft continues to be superior and should be the choice in children with end-stage renal disease.
authors.affiliation: Department of Surgery, University of Minnesota Medical School and University of Minnesota Masonic Children's Hospital, Minneapolis, MN. Electronic address: chinni@umn.edu.
authors.forename: Srinath
authors.initials: S
authors.lastname: Chinnakotla
authors.affiliation: Department of Pediatrics, University of Minnesota Medical School and University of Minnesota Masonic Children's Hospital, Minneapolis, MN.
authors.forename: Priya
authors.initials: P
authors.lastname: Verghese
authors.affiliation: Department of Pediatrics, University of Minnesota Medical School and University of Minnesota Masonic Children's Hospital, Minneapolis, MN.
authors.forename: Blanche
authors.initials: B
authors.lastname: Chavers
authors.affiliation: Department of Pediatrics, University of Minnesota Medical School and University of Minnesota Masonic Children's Hospital, Minneapolis, MN.
authors.forename: Michelle N
authors.initials: MN
authors.lastname: Rheault
authors.affiliation: Department of Surgery, University of Minnesota Medical School and University of Minnesota Masonic Children's Hospital, Minneapolis, MN.
authors.forename: Varvara
authors.initials: V
authors.lastname: Kirchner
authors.affiliation: Department of Surgery, University of Minnesota Medical School and University of Minnesota Masonic Children's Hospital, Minneapolis, MN.
authors.forename: Ty
authors.initials: T
authors.lastname: Dunn
authors.affiliation: Department of Pediatrics, University of Minnesota Medical School and University of Minnesota Masonic Children's Hospital, Minneapolis, MN.
authors.forename: Clifford
authors.initials: C
authors.lastname: Kashtan
authors.affiliation: Department of Pediatrics, University of Minnesota Medical School and University of Minnesota Masonic Children's Hospital, Minneapolis, MN.
authors.forename: Thomas
authors.initials: T
authors.lastname: Nevins
authors.affiliation: Department of Pediatrics, University of Minnesota Medical School and University of Minnesota Masonic Children's Hospital, Minneapolis, MN.
authors.forename: Michael
authors.initials: M
authors.lastname: Mauer
authors.affiliation: Department of Surgery, University of Minnesota Medical School and University of Minnesota Masonic Children's Hospital, Minneapolis, MN.
authors.forename: Timothy
authors.initials: T
authors.lastname: Pruett
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007223:Infant; D007231:Infant, Newborn; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000401:mortality / Q000601:surgery*; D016030:Kidney Transplantation / Q000401:mortality; D019520:Living Donors; D008297:Male; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents