Skip to main content
SpringerLink
Log in

Causes of kidney allograft loss in a large pediatric population at a single center

  • Original Article
  • Published:
Pediatric Nephrology Aims and scope Submit manuscript

Abstract

At our institution, 521 kidney transplants were performed in 429 children (mean age 8.7±5.6-years) between 1969 and 1991. Of these transplants, 408 were primary, 113 were retransplants, 347 were living related, 171 were cadaver, and 3 were living nonrelated. Immunosuppression consisted of prednisone, azathioprine, and Minnesota antilymphocyte globulin (non-CSA) in 339 patients, total lymphoid irradiation in 8, and, more recently, cyclosporine (CSA) in addition in 168 patients. Average followup was 8.8±6.0 years.

Actuarial graft survival in the non-CSA versus CSA groups at 1 year was 77.0% versus 85.7%; at 5 years, 59.6% versus 71.9%. Of 136 non-CSA patients, causes of graft loss at 5 years included: chronic rejection in 55 (40.4%), acute rejection in 27 (19.9%), recurrent disease in 16 (11.8%), technical complications in 8 (5.9%), infectious complications in 4 (2.9%), other causes in 5 (3.7%), and death with a functioning graft in 21 (15.4%). Of 40 CSA patients, causes of graft loss at 5 years included: chronic rejection in 16 (40.0%), acute rejection in 8 (20.0%), recurrent disease in 6 (15.0%), technical complications in 3 (7.5%), other causes in 2 (5.0%), and death with a functioning graft in 5 (12.5%).

The causes of graft loss did not significantly differ in the non-CSA and CSA groups. Chronic rejection was the most common cause of graft loss in both groups. Research focusing on chronic rejection is needed to improve graft outcome in pediatric kidney transplantation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Chavers BM, Matas AJ, Nevins TE, Mauer SM, Sutherland DER, Payne WD, Dunn D, Gillingham K, Najarian JS (1990) Results of pediatric kidney transplantation at the University of Minnesota. In: Terasaki P (ed) Clinical transplants 1989. UCLA Tissue Typing Laboratory, Los Angeles, pp 253–266

    Google Scholar 

  2. Simmons RL, Canafax DM, Fryd DS, Ascher NL, Payne WD, Sutherland DER, Najarian JS (1986) New immunosuppressive drug combinations for mismatched related and cadaveric renal transplantation. Transplant Proc 18 [Suppl 1]: 76–81

    PubMed  Google Scholar 

  3. Sheldon CA, Churchill BM, McLorie GA, Arbus GS (1992) Evaluation of factors contributing to mortality in pediatric renal transplant recipients. J Pediatr Surg 27: 629–633

    PubMed  Google Scholar 

  4. Abitbol CL, Burke GW, Zilleruelo G, Montane B, Strauss J (1991) Clinical management of the pediatric renal-allograft recipient. Child Nephrol Urol 11: 169–178

    PubMed  Google Scholar 

  5. Ettenger R, Marik J, Rosenthal JT (1992) Sequential therapy in pediatric cadaveric renal transplantation: a critical analysis. J Am Soc Nephrol 2 [Suppl 3]: S304–S311

    PubMed  Google Scholar 

  6. McEnery PT, Stablein DM (1992) Does human lymphocyte antigen matching improve the outcome in pediatric renal transplants? J Am Soc Nephrol 2 [Suppl 3]: S234–S237

    PubMed  Google Scholar 

  7. Nevins TE, Dunn DL (1992) Use of ganciclovir for cytomegalovirus infection. J Am Soc Nephrol 2 [Suppl 3]: S270–S273

    PubMed  Google Scholar 

  8. Miller LC, Bock GH, Lum CT, Najarian AJS, Mauer SM (1982) Transplantation of the adult kidney into the very small child: longterm outcome. J Pediatr 100: 675–680

    PubMed  Google Scholar 

  9. Matas AJ, Sibley R, Mauer SM, Sutherland DER, Simmons RL, Najarian JS (1983) The value of needle renal allograft biopsy. A retrospective study of biopsies performed during putative rejection episodes. Ann Surg 197: 226–237

    PubMed  Google Scholar 

  10. Gehan E (1965) A generalized Wilcoxon test for comparing arbitrarily singly-censored samples. Biometrika 52: 203–223

    PubMed  Google Scholar 

  11. Offner G, Hoyer PF, Brodehl J, Pichlmayr R (1987) Cyclosporine A in pediatric kidney transplantation. Pediatr Nephrol 1: 125–130

    PubMed  Google Scholar 

  12. Alexander SR, Arbus GS, Butt KMH, Conley S, Fine RN, Greifer I, Gruskin AB, Harmon WE, McEnery PT, Nevins TE, Nogueira N, Salvatierra O Jr, Tejani A (1990) The 1989 report of the North American Pediatric Renal Transplant Cooperative Study. Pediatr Nephrol 4: 542–553

    PubMed  Google Scholar 

  13. Ettenger RB, Rosenthal JT, Marik J, Nelson P, Malekzadeh M, Grimm PC, Kamil ES, Salusky IB, Fine RN (1990) Cadaver renal transplantation in children: results with long-term cyclosporine immunosuppression. Clin Transplant 4: 329–336

    Google Scholar 

  14. Schweitzer EJ, Matas AJ, Gillingham KJ, Payne WD, Gores PF, Dunn DL, Sutherland DER, Najarian JS (1991) Causes of renal allograft loss: progress in the 1980s, challenges for the 1990s. Ann Surg 214: 679–688

    PubMed  Google Scholar 

  15. Gruber SA, Chavers B, Skjei KL, Sothern RB, Robison L, Tzardis P, Moss A, Gillingham K, Canafax DM, Najarian JS, Matas AJ, Dun DL (1991) De novo cancer after pediatric kidney transplantation. Transplant Proc 23: 1373–1374

    Google Scholar 

  16. Penn I (1991) Occurrence of cancers in immunosuppressed organ transplant recipients. In: Terasaki P (ed) Clinical transplants 1990. UCLA Tissue Typing Laboratory, Los Angeles, pp 53–62

    Google Scholar 

  17. Melosky B, Karim M, Chui A, McBride M, Cameron EC, Yeung CK, Landsberg D, Shackleton C, Keown PA (1992) Lymphoproliferative disorders after renal transplantation in patients receiving triple or quadruple immunosuppression. J Am Soc Nephrol 2: S290–S294

    PubMed  Google Scholar 

  18. Broyer M, on behalf of the, European Dialysis and Transplant Association Registry Committee (1989) Kidney transplantation in children — data from the EDTA Registry. Transplant Proc 21: 1985–1988

    PubMed  Google Scholar 

  19. Broyer M, Selwool N, Brunner F (1992) Recurrence of primary renal disease on kidney graft: a European pediatric experience. J Am Soc Nephrol 2: S255–S257

    PubMed  Google Scholar 

  20. McEnery PT, Stablein DM, Arbus G, Tejani A (1992) Renal transplantation in children. A report of the North American Pediatric Renal Transplant Cooperative Study. N Engl J Med 326: 1727–1732

    PubMed  Google Scholar 

  21. Stephanian E, Matas AJ, Mauer SM, Chavers B, Nevins T, Kashtan C, Sutherland DER, Gores P, Najarian JS (1992) Recurrence of disease in patients retransplanted for focal segmental glomerulosclerosis. Transplantation 53: 755–757

    PubMed  Google Scholar 

  22. Striegel JE, Sibley RK, Fryd DS, Mauer SM (1986) Recurrence of focal segmental glomerulosclerosis in children following renal transplantation. Kidney Int 30: S44–S50

    Google Scholar 

  23. Senggutuvan P, Cameron JS, Hartley RB, Rigden S, Chantler C, Haycock G, Williams DG, Ogg C, Koffman G (1990) Recurrence of focal segmental glomerulosclerosis in transplanted kidneys: analysis of incidence and risk factors in 59 allografts. Pediatr Nephrol 4: 21–28

    PubMed  Google Scholar 

  24. Ingulli E, Tejani A (1991) Incidence, treatment, and outcome of recurrent focal segmental glomerulosclerosis posttransplantation in 42 allografts in children — a single-center experience. Transplantation 51: 401–405

    PubMed  Google Scholar 

  25. Jones RM, Murie JA, Ting A, Dunnill MS, Morris PJ (1988) Renal vascular thrombosis of cadaveric renal allografts in patients receiving cyclosporin, azathioprine and prednisolone triple therapy. Clin Transplant 2: 122–126

    Google Scholar 

  26. Gruber SA, Chavers B, Payne WD, Fryd DS, Canafax DM, Simmons RL, Najarian JS, Matas A (1989) Allograft renal vascular thrombosis — lack of increase with cyclosporine immunosuppression. Transplantation 47: 475–478

    PubMed  Google Scholar 

  27. Harmon WE, Stablein D, Alexander SR, Tejani A (1991) Graft thrombosis in pediatric renal transplant recipients. A report of the North American Pediatric Renal Transplant Cooperative Study. Transplantation 51: 406–412

    PubMed  Google Scholar 

  28. Myers BD, Sibley R, Newton L, Tomlanovich SJ, Boshkos C, Stinson E, Luetscher JA, Whitney DJ, Krasny D, Coplon NS, Perlroth MG (1988) The long-term course of cyclosporine-associated chronic nephropathy. Kidney Int 333: 590–600

    Google Scholar 

  29. Ettenger RB, Blifeld C, Prince H, Gradus DB, Cho S, Sekiya N, Salusky IB, Fine RN (1987) The pediatric nephrologist's dilemma: growth after renal transplantation and its interaction with age as a possible immunologic variable. J Pediatr 111: 1022–1025

    PubMed  Google Scholar 

  30. Offner G, Hoyer PF, Juppner H, Krohn HP, Brodehl J (1987) Somatic growth after kidney transplantation. Beneficial effect of cyclosporine in comparison with conventional immunosuppression. Am J Dis Child 141: 541–546

    PubMed  Google Scholar 

  31. So SKS, Chang PN, Najarian JS, Mauer SM, Simmons RL, Nevins TE (1987) Growth and development in infants after renal transplantation. J Pediatr 110: 343–350

    PubMed  Google Scholar 

  32. Bosque M, Munian A, Bewick M, Haycock G, Chantler C (1983) Growth after renal transplants. Arch Dis Child 58: 110–114

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pediatrics, University of Minnesota, 13-240 Moos Tower, 515 Delaware Street S. E., Box 491 UMHC, 55455, Minneapolis, MN, USA

    Blanche M. Chavers, Eun-Mi Kim & S. Michael Mauer

  2. Department of Surgery, University of Minnesota, 13-240 Moos Tower, 515 Delaware Street S. E., Box 491 UMHC, 55455, Minneapolis, MN, USA

    Arthur J. Matas, Kristen J. Gillingham & John S. Najarian

Authors
  1. Blanche M. Chavers
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Eun-Mi Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Arthur J. Matas
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kristen J. Gillingham
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. John S. Najarian
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. S. Michael Mauer
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Chavers, B.M., Kim, EM., Matas, A.J. et al. Causes of kidney allograft loss in a large pediatric population at a single center. Pediatr Nephrol 8, 57–61 (1994). https://doi.org/10.1007/BF00868263

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF00868263

Key words

Search

Navigation