Factors associated with acute rejection after pediatric kidney transplantation: a single-center cohort study
10.3760/cma.j.cn421203-20221201-00316
- VernacularTitle:儿童肾移植术后急性排斥反应相关影响因素的单中心队列研究
- Author:
Zhiliang GUO
1
;
Rula SA
;
Lan ZHU
;
Guangyuan ZHAO
;
Daqiang ZHAO
;
Hui GUO
;
Bin LIU
;
Jipin JIANG
;
Zhishui CHEN
;
Gang CHEN
Author Information
1. 华中科技大学同济医学院附属同济医院器官移植研究所，器官移植教育部重点实验室，国家卫生健康委员会器官移植重点实验室，中国医学科学院器官移植重点实验室，武汉 430030
- Keywords:
Child;
Kidney transplantation;
Acute rejection;
Immune induction therapy
- From:
Chinese Journal of Organ Transplantation
2023;44(2):68-74
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To summarize the incidence of acute rejection (AR) after pediatric kidney transplantation (KT) at a single center and examine its impact on graft/patient survival and risk factors for AR.Methods:This is a retrospective cohort study including pediatric recipients who underwent kidney transplantation in past 8 years.After excluding recipients of graft thrombosis within a week post-transplant and lost to follow-ups, a total of 143 cases were ultimately recruited and assigned into two groups of AR (n=29) and non-AR (n=114).Basic profiles of both donors and recipients and graft/patient survival rate were compared between two groups.Relative risk factors for AR episodes were also examined by Logistic regression.Results:Renal grafts for 130/143 cases (90.9%) were harvested from deceased donors and 120(83.9%) cases from children.Twenty-seven transplants (18.9%) were performed in infants and young recipients aged < 3 years.During a median follow-up of 33 months, 34 AR episodes occurred in 29(20.3%) patients.Rate of re-transplantation (27.6% vs. 7.9%), pediatric donor (96.5% vs. 80.7%) and rabbit anti-human thymocyte globulin (rATG) induction (79.3% vs. 36%) were significantly higher in AR group than non-AR group ( P=0.007, P=0.046, P<0.001).Multivariate regression analysis indicated that basiliximab induction caused a significant reduction in the risk of AR incidence as compared with rATG induction (odds ratio 0.13, 95% confidence interval 0.04-0.43, P<0.001).The median time of AR incidence was 1.3 months post-transplantation and 23 episodes (67.6%) were confirmed by biopsy.After anti-rejection treatment, 52.9%(n=18) of the cases achieved a full recovery and 38.3% (n=13) had improved graft function.However, 3 cases (8.8%) developed irreversible graft failure.The 1/3-year graft survival rates were significantly lower in AR group than those in non-AR group (75.3% vs. 95.2%, 68.4% vs. 90.4%, P=0.01), and there was no significant difference in 1-and 3-year patient survival rates between two groups. Conclusions:The incidence of AR is relatively high in pediatric renal transplantation, which has an impact on graft survival.Basiliximab induction can effectively reduce the risk of AR.
