ESPN 54th Annual Meeting

ESPN 2022


 
TIME-DEPENDENT EFFECTS OF DONOR AND RECIPIENT CHARACTERISTCS ASSOCIATED WITH GRAFT SURVIVAL AFTER FIRST PAEDIATRIC KIDNEY TRANSPLANTATION: EUROTRANSPLANT REGISTRY ANALYSIS
FERRAN COENS 1 NOëL KNOPS 2 INEKE TIEKEN 4 SERGE VOGELAAR 4 JON JIN KIM 3 AGNIESZKA PRYTULA 1

1- DEPARTMENT OF PEDIATRIC NEPHROLOGY AND RHEUMATOLOGY, GHENT UNIVERSITY HOSPITAL, GHENT, BELGIUM
2- DEPARTMENT OF PEDIATRIC NEPHROLOGY, UNIVERSITY HOSPITAL LEUVEN, LEUVEN, BELGIUM
3- NOTTINGHAM UNIVERSITY HOSPITAL NHS TRUST, UNITED KINGDOM
4- EUROTRANSPLANT, LEIDEN, THE NETHERLANDS
 
Introduction:

 

The aim of this study was to identify time-dependent effects of factors associated with time to death-censored graft survival after paediatric kidney transplantation (KTx).

 

Material and methods:

Data on patients younger than 18 years at primary KTx between 1990 and 2020 were provided by the Eurotransplant Registry. A piecewise-exponential additive mixed model with country level frailty was applied to explore time-varying variables associated with time until death-censored graft loss (DCGL) after first paediatric kidney transplantation. 

Results:

 We included 4528 KTx recipients with median age at KTx 11 years (interquartile range [IQR] 6-14) and median follow-up of 10 years (IQR 4-17). During the follow-up 1688 patients (37.3%) experienced graft failure (GF) and 159 (3.5%) died with functioning graft. The respective 5-year GF after live (LD) and deceased donor (DD) KTx performed in 1990-2000 were 14% and 25% as compared to 4% and 12% in KTx between 2011-2020. There was a time-varying association between time to DCGL (P<0.05) and donor source, recipient and donor age and panel reactive antibodies (PRA). The benefit of LD was most pronounced in the first months after KTx, then decreased steadily and was no longer significant from 130 months on. Increasing recipient age corresponded with a decline in adjusted hazard ratio (aHR) for DCGL in the first months post KTx, but had the opposite effect between 50 and 100 months. Donor age of 20 years corresponded with the lowest aHR for DCGL. Panel reactive antibodies (PRA) 1-15% was associated with a higher aHR than PRA 0% up until 50 months post KTx. The aHR for DCGL decreased with ascending year of KTx up until 2000 and remained stable afterwards.

Conclusions:

 The effects of factors associated with DCGL vary over time and should be considered at clinical decision making.