Risk factors associated with allograft failure in pediatric kidney transplant recipients with focal segmental glomerulosclerosis.

Autor: Koh LJ; Paediatric Nephrology, National University Hospital System, Singapore, Singapore.; Pediatric Nephrology, BC Children's Hospital, Vancouver, British Columbia, Canada., Martz K; EMMES Corporation, Rockville, Maryland, United States of America., Blydt-Hansen TD; Multi Organ Transplant Program, BC Children's Hospital, Vancouver, British Columbia, Canada.
Jazyk: angličtina
Zdroj: Pediatric transplantation [Pediatr Transplant] 2019 Aug; Vol. 23 (5), pp. e13469. Date of Electronic Publication: 2019 Jun 06.
DOI: 10.1111/petr.13469
Abstrakt: Background: With improved outcomes for children transplanted with FSGS since previous NAPRTCS registry reports, this study re-evaluates the association of living donation, immunosuppression, and DGF on graft survival.
Setting: Patients transplanted between 2002 and 2016, comparing FSGS diagnosis vs other glomerular diseases.
Methods: Primary outcomes were allograft survival and FSGS recurrent-free graft survival. Potential risk factors were obtained at the time of transplant and up to 30 days post-transplantation. Analysis considered a priori that DGF may be a proxy for severe FSGS recurrence. Multivariable survival models for outcome were tested for sensitivity without/with DGF to determine features independent of recurrence.
Results: From the larger cohort of 3010 patients, 5-year graft survival in children with FSGS (n = 455) was worse (74.3%) compared with other glomerular diseases (87.1%, n = 690) (HR 1.45, P = 0.033). Modeling all glomerular diseases, survival risk was associated with deceased donor (HR 1.83, P = 0.002), re-transplantation (HR 1.58, P = 0.013), and recipient age (HR 1.06/y, P = 0.002). The living donor advantage was not confirmed in a FSGS model (HR 1.51 for deceased, P = 0.12). DGF was highly associated with graft failure (HR 4.39, P < 0.001) and independent of re-transplant history but not FSGS diagnosis. Induction agents or primary immunosuppression choices were not associated with survival.
Conclusion: Graft survival rates have improved since the previous report. Living donor did not predict graft failure, but there remains no survival advantage. DGF was the primary independent predictor for graft loss secondary to FSGS recurrence, consistent with DGF being a proxy for severe recurrent disease.
(© 2019 Wiley Periodicals, Inc.)
Databáze: MEDLINE
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