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Paediatric kidney transplantation: A single-centre experience of 16 years
32nd Annual EAU Congress, 24-28 March 2017, London, United Kingdom
468
Paediatric kidney transplantation: A single-centre experience of 16 years Eur Urol Suppl 2017; 16(3);e810
Bañuelos Marco B.1, Koch T-M.2, Friedersdorff F.1, Goranova I.1, Lingnau A.1 1
Charité - Universitätsmedizin Berlin, Dept. of Urology, Berlin, Germany, 2Charité - Universitätsmedizin Berlin, Dept. of Paediatric Nephrology, Berlin, Germany INTRODUCTION & OBJECTIVES: Renal Transplantation remains the treatment of choice for children with end stage renal disease. Our aim was to evaluate the effect of patient, surgical, and medical factors on the surgical complications and graft function following Tx in children. MATERIAL & METHODS: 143 Children and adolescent transplantations in a single centre from January 1997 to May 2013 were assessed retrospectively. We analyzed long-term survival rates and complications and searched for predictive parameters for graft function. RESULTS: 143 kidney transplantations were performed in 132 patients. Mean age at transplantation was 11.5±4.8 years. The percentage of living kidney donation was 24.5% (35/143). Mean donor age was 33.3±19.6 years. Rejections occurred in 44.1% (63/143). Graft survival rates were 92.2%, 85.5%, 71.1% and 62.1% after 1,5,10 and 15 years respectively. The following variables concerning graft survival showed statistic significance: Transplantation Era, donor age, High Urgency,postoperative Epo use, cold ischemia, retransplantation, rejections proved by biopsy and panel reactive antibodies after transplantation (Table 1). Overall Mortality is 5.6%. The mean patient survival was 8.8±5.0 years. Overall Survival was 99.3%, 95.2%, 94.2%. 90.7% after 1,5,10 and 15 years respectively. Re-transplantation (p=0.022) and Post-Transplant-Lymphoproliferative-Disorders (p=0.002) are significant parameters for patient survival. Infections were the main causes of death.
Eur Urol Suppl 2017; 16(3);e810
32nd Annual EAU Congress, 24-28 March 2017, London, United Kingdom
468
Paediatric kidney transplantation: A single-centre experience of 16 years Eur Urol Suppl 2017; 16(3);e811
Table 1
Variables Donor Recipient
Donor
Recipient
Dialysis Operative Factors
PostOP
Year of transplant Transplantation Era Mismatches
Factors affecting Graft and Patient Survival Graft Graft OM OS function survival Recipient p- Recipient p-value log Rank value log Rank p-value p-value <0,001 <0,001 <0,001 0,113 0,683
0,186
0,845
n.a
Body weight ratio
0,547
n.a
0,069
n.a
Hypotension Age Sex Diagnosis Previous operations
0,027 0,071 0,110 0,736 0,227
0,148 0,00001 n.a n.a n.a
0,530 0,062 0,319 0,949 0,790
n.a n.a n.a n.a n.a
Transfusions Age Sex Migration background Residual Urine HU Retransplants preemptive transplantation Type Duration En-Bloc Side & right/left Kidney Ischemia Warm Cold overall Stenosis/Thrombosis complications ATN
0,153 0,159 0,551 0,787 0,100 0,573 0,004 0,350 0,538 0,425 0,335 n.s 0,589 0,017 0,050 0,004 0,068 0,456
0,082 n.a n.a n.a n.a 0,014 0,003 0,199 n.a n.a 0,600 n.s n.a 0,047 0,008 0,000 n.a 0,333
0,350 0,745 0,364 0,714 0,257 n.a 0,048 0,338 0,542 0,423 0,451 n.s 0,795 0,899 0,391 0,285 0,759 0,081
0,976 n.a n.a n.a n.a 0,163 n.a 0,352 n.a n.a 0,774 n.s n.a n.a n.a 0,434 n.a 0,293
Eur Urol Suppl 2017; 16(3);e811
32nd Annual EAU Congress, 24-28 March 2017, London, United Kingdom
468
Paediatric kidney transplantation: A single-centre experience of 16 years Eur Urol Suppl 2017; 16(3);e812
Rejections episodes Factors Biopsie Rejections Initial Function Dialysis postOP Hypertension Intensive Care PostOP Time of hospitalization Factors Rehab Epo Donor CD/LD Long Term Non Compliance PTLD/Tumor Infections CMV UTI
<0,001 0,067 0,003 0,238 0,110 0,646 <0,001 0,032 0.001 0,039 0,013
0,008 0,000 0,006 n.a 0,019 n.a n.a 0,216 0,001 0,163 n.a
n.a
n.a
0,793 n.a 0,681 0,073 0,529 0,847 0,031 0,972 0,265
0,141 0,901 n.a n.a n.a n.a n.a n.a n.a
n.a 0,676
n.a n.a
0,003 0,361 0,027
0,002 n.a
0,693
n.a
0,070
n.a
CONCLUSIONS: Renal transplantation in children is a safe and successful procedure. Due to new immunosuppressive medication, decreased number of rejections and improvement of transplant- and patient outcome were seen. Influencing factors on graft survival e.g. of donor age and condition, cold ischemia time should be taken into account for allocating the organ.
Eur Urol Suppl 2017; 16(3);e812 Powered by TCPDF (www.tcpdf.org)
468
Paediatric kidney transplantation: A single-centre experience of 16 years Eur Urol Suppl 2017; 16(3);e810
Bañuelos Marco B.1, Koch T-M.2, Friedersdorff F.1, Goranova I.1, Lingnau A.1 1
Charité - Universitätsmedizin Berlin, Dept. of Urology, Berlin, Germany, 2Charité - Universitätsmedizin Berlin, Dept. of Paediatric Nephrology, Berlin, Germany INTRODUCTION & OBJECTIVES: Renal Transplantation remains the treatment of choice for children with end stage renal disease. Our aim was to evaluate the effect of patient, surgical, and medical factors on the surgical complications and graft function following Tx in children. MATERIAL & METHODS: 143 Children and adolescent transplantations in a single centre from January 1997 to May 2013 were assessed retrospectively. We analyzed long-term survival rates and complications and searched for predictive parameters for graft function. RESULTS: 143 kidney transplantations were performed in 132 patients. Mean age at transplantation was 11.5±4.8 years. The percentage of living kidney donation was 24.5% (35/143). Mean donor age was 33.3±19.6 years. Rejections occurred in 44.1% (63/143). Graft survival rates were 92.2%, 85.5%, 71.1% and 62.1% after 1,5,10 and 15 years respectively. The following variables concerning graft survival showed statistic significance: Transplantation Era, donor age, High Urgency,postoperative Epo use, cold ischemia, retransplantation, rejections proved by biopsy and panel reactive antibodies after transplantation (Table 1). Overall Mortality is 5.6%. The mean patient survival was 8.8±5.0 years. Overall Survival was 99.3%, 95.2%, 94.2%. 90.7% after 1,5,10 and 15 years respectively. Re-transplantation (p=0.022) and Post-Transplant-Lymphoproliferative-Disorders (p=0.002) are significant parameters for patient survival. Infections were the main causes of death.
Eur Urol Suppl 2017; 16(3);e810
32nd Annual EAU Congress, 24-28 March 2017, London, United Kingdom
468
Paediatric kidney transplantation: A single-centre experience of 16 years Eur Urol Suppl 2017; 16(3);e811
Table 1
Variables Donor Recipient
Donor
Recipient
Dialysis Operative Factors
PostOP
Year of transplant Transplantation Era Mismatches
Factors affecting Graft and Patient Survival Graft Graft OM OS function survival Recipient p- Recipient p-value log Rank value log Rank p-value p-value <0,001 <0,001 <0,001 0,113 0,683
0,186
0,845
n.a
Body weight ratio
0,547
n.a
0,069
n.a
Hypotension Age Sex Diagnosis Previous operations
0,027 0,071 0,110 0,736 0,227
0,148 0,00001 n.a n.a n.a
0,530 0,062 0,319 0,949 0,790
n.a n.a n.a n.a n.a
Transfusions Age Sex Migration background Residual Urine HU Retransplants preemptive transplantation Type Duration En-Bloc Side & right/left Kidney Ischemia Warm Cold overall Stenosis/Thrombosis complications ATN
0,153 0,159 0,551 0,787 0,100 0,573 0,004 0,350 0,538 0,425 0,335 n.s 0,589 0,017 0,050 0,004 0,068 0,456
0,082 n.a n.a n.a n.a 0,014 0,003 0,199 n.a n.a 0,600 n.s n.a 0,047 0,008 0,000 n.a 0,333
0,350 0,745 0,364 0,714 0,257 n.a 0,048 0,338 0,542 0,423 0,451 n.s 0,795 0,899 0,391 0,285 0,759 0,081
0,976 n.a n.a n.a n.a 0,163 n.a 0,352 n.a n.a 0,774 n.s n.a n.a n.a 0,434 n.a 0,293
Eur Urol Suppl 2017; 16(3);e811
32nd Annual EAU Congress, 24-28 March 2017, London, United Kingdom
468
Paediatric kidney transplantation: A single-centre experience of 16 years Eur Urol Suppl 2017; 16(3);e812
Rejections episodes Factors Biopsie Rejections Initial Function Dialysis postOP Hypertension Intensive Care PostOP Time of hospitalization Factors Rehab Epo Donor CD/LD Long Term Non Compliance PTLD/Tumor Infections CMV UTI
<0,001 0,067 0,003 0,238 0,110 0,646 <0,001 0,032 0.001 0,039 0,013
0,008 0,000 0,006 n.a 0,019 n.a n.a 0,216 0,001 0,163 n.a
n.a
n.a
0,793 n.a 0,681 0,073 0,529 0,847 0,031 0,972 0,265
0,141 0,901 n.a n.a n.a n.a n.a n.a n.a
n.a 0,676
n.a n.a
0,003 0,361 0,027
0,002 n.a
0,693
n.a
0,070
n.a
CONCLUSIONS: Renal transplantation in children is a safe and successful procedure. Due to new immunosuppressive medication, decreased number of rejections and improvement of transplant- and patient outcome were seen. Influencing factors on graft survival e.g. of donor age and condition, cold ischemia time should be taken into account for allocating the organ.
Eur Urol Suppl 2017; 16(3);e812 Powered by TCPDF (www.tcpdf.org)