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Increased incidence of renal transplant arterial stenosis in children
P H Henning1, M Bewick, J F Reidy
1Evelina Children's Department, Guy's Hospital, London, UK.
Insights
Clinically significant transplant arterial stenosis increased with cyclosporin use. Small donor kidneys, especially from children under 6, were the primary risk factor for this stenosis, impacting renal transplantation outcomes.
Area of Science:
- Nephrology
- Transplantation immunology
- Vascular surgery
Background:
- The introduction of cyclosporin has coincided with an increased incidence of transplant arterial stenosis.
- A concurrent rise in the utilization of donor kidneys from young children (<6 years) has been observed.
Purpose of the Study:
- To investigate the incidence and risk factors associated with clinically significant transplant arterial stenosis.
- To evaluate the relationship between immunosuppressive therapy and transplant arterial stenosis.
- To determine the impact of donor kidney size on transplant arterial stenosis.
Main Methods:
- Retrospective analysis of renal transplant recipients.
- Comparison of stenosis incidence between cyclosporin and azathioprine immunosuppression protocols.
- Correlation analysis between donor age, donor kidney size, and transplant arterial stenosis.
Main Results:
- The incidence of transplant arterial stenosis rose from 10% to 16.4% following cyclosporin introduction.
- In cyclosporin-treated patients, stenosis was not linked to anastomosis or rejection.
- Patients on azathioprine with stenosis showed a higher incidence of rejection.
- The use of small donor kidneys was the most significant factor associated with transplant arterial stenosis, irrespective of immunosuppression.
Conclusions:
- Small donor kidneys are a critical risk factor for transplant arterial stenosis.
- This finding has significant implications for pediatric cadaveric renal transplantation strategies.
- Further research into donor selection criteria and strategies to mitigate stenosis risk is warranted.
Abstract:
We have found an increase from 10% to 16.4% in the incidence of clinically significant transplant arterial stenosis since the introduction of cyclosporin immunosuppression. During the same period there has been a coincidental increase in the use of donor kidneys harvested from children less than 6 years of age. In patients treated with cyclosporin these stenoses of the donor artery are not related to the surgical anastomosis, and have only rarely been associated with clinical or histological evidence of rejection, whereas those patients who have developed transplant arterial stenosis whilst receiving azathioprine have had a higher incidence of rejection. Regardless of immunosuppressive regimes, the use of small donor kidneys appears to be the most significant association with transplant arterial stenosis in our experience, and this finding has major implications for cadaveric renal transplantation in children.