Kidney transplantation in children with CAKUT and non-CAKUT causes of chronic kidney disease: Do they have the same outcomes?

Autor: Monteverde ML; Nephrology Unit, Hospital de Pediatría JP Garrahan, Buenos Aires, Argentina., Paz M; Nephrology Unit, Hospital de Pediatría JP Garrahan, Buenos Aires, Argentina., Ibáñez JP; Nephrology Unit, Hospital de Pediatría JP Garrahan, Buenos Aires, Argentina., Chaparro AB; Nephrology Unit, Hospital de Pediatría JP Garrahan, Buenos Aires, Argentina., Solernou V; Pathology Unit, Hospital de Pediatría JP Garrahan, Buenos Aires, Argentina., Sager C; Urology Unit, Hospital de Pediatría JP Garrahan, Buenos Aires, Argentina., Tessi C; Urology Unit, Hospital de Pediatría JP Garrahan, Buenos Aires, Argentina., Locane F; Nephrology Unit, Hospital de Pediatría JP Garrahan, Buenos Aires, Argentina.
Jazyk: angličtina
Zdroj: Pediatric transplantation [Pediatr Transplant] 2020 Dec; Vol. 24 (8), pp. e13763. Date of Electronic Publication: 2020 Oct 04.
DOI: 10.1111/petr.13763
Abstrakt: Almost half the children who undergo kidney transplantation (KTx) have congenital abnormalities of the kidney and urinary tract (CAKUT). We compared patient, graft survival, and kidney function at last follow-up between CAKUT and non-CAKUT patients after KTx. We divided the analysis into two eras: 1988-2000 and 2001-2019. Of 923 patients, 52% had CAKUT and 48% non-CAKUT chronic kidney disease (CKD). Of the latter, 341 (77%) had glomerular disease, most frequently typical HUS (32%) and primary FSGS (27%); 102 had non-glomerular disease. CAKUT patients were more often boys, younger at KTx, transplanted more frequently preemptively, but with longer time on chronic dialysis. They had less delayed graft function (DGF) and better eGFR, but higher incidence of urinary tract infection (1 year post-KTx). In both eras, 1-, 5-, and 10-year patient survival was similar in the groups, but graft survival was better in CAKUT recipients vs those with primary glomerular and primary recurrent glomerular disease: Era 1, 92.3%, 80.7%, and 63.6% vs 86.9%, 70.6%, and 49.5% (P = .02), and 76.7%, 56.6%, and 34% (P = .0003); Era 2, 96.2%, 88%, and 73.5% vs 90.3%, 76.1%, and 61% (P = .0075) and 75.4%, 54%, and 25.2% (P < .0001), respectively. Main predictors of graft loss were DGF, late acute rejection (AR), and age at KTx in CAKUT group and disease relapse, DGF, early AR, and number of HLA mismatches in recipients with glomerular disease. Graft survival was better in CAKUT patients. DGF was the main predictor of graft loss in all groups. Disease recurrence and early AR predicted graft failure in patients with glomerular disease.
(© 2020 Wiley Periodicals LLC.)
Databáze: MEDLINE
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