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End-stage kidney disease after pediatric nonrenal solid organ transplantation

Rebecca L Ruebner1, Peter P Reese, Michelle R Denburg

  • 1MSCE, Children's Hospital of Philadelphia, Division of Nephrology 1 Main, 34th St and Civic Center Blvd, Philadelphia, PA 19104. ruebnerr@email.chop.edu.

Pediatrics
|October 16, 2013
PubMed

Insights

Pediatric solid organ transplant recipients face a significant risk of end-stage kidney disease (ESKD), particularly after intestinal and lung transplants. Early intervention targeting risk factors is crucial for preventing kidney damage in these children.

Area of Science:

  • Pediatric Nephrology
  • Transplantation Medicine
  • Public Health

Background:

  • Solid organ transplant (SOT) recipients often develop advanced kidney disease.
  • The incidence and risk factors for end-stage kidney disease (ESKD) in pediatric SOT recipients are not well understood.
  • Understanding ESKD burden in children post-SOT is critical for improving long-term outcomes.

Purpose of the Study:

  • To determine the incidence of ESKD in children following SOT.
  • To assess the relative risk of ESKD based on the type of SOT received.
  • To identify high-risk groups for targeted interventions.

Main Methods:

  • Retrospective analysis of a national cohort of pediatric SOT recipients (ages ≤ 18) from 1990-2010.
  • Utilized Scientific Registry of Transplant Recipients and US Renal Data System data.
  • Employed competing risks analysis and multivariable Cox regression to evaluate ESKD incidence and organ-specific risks.

Main Results:

  • The study included 16,604 pediatric SOT recipients.
  • A total of 426 (3%) children developed ESKD during a median follow-up of 6.2 years.
  • Intestinal (HR 7.37) and lung (HR 5.79) transplant recipients had the highest adjusted risk of ESKD compared to liver recipients.

Conclusions:

  • Pediatric SOT recipients, especially those undergoing intestinal and lung transplants, are at the highest risk for developing ESKD.
  • The actual burden of chronic kidney disease may be substantially higher than reported ESKD rates.
  • Targeting modifiable risk factors is essential to prevent progressive kidney damage in this vulnerable population.
Abstract

Keywords:
end-stage renal failurenephrologytransplant

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