Clinical Outcomes in Pediatric Renal Transplant Recipients Who Received Steroid-Based Immunosuppressive Regimen

Area of Science:

• Nephrology
• Pediatric Surgery
• Transplantation Immunology

Background:

• Pediatric renal transplantation (RT) outcomes vary significantly between developed and developing countries.
• Limited data exists on RT outcomes in developing nations, necessitating further research.

Purpose of the Study:

• To evaluate clinical outcomes of pediatric renal transplantation in Thailand.
• To identify factors influencing graft function and survival in young RT recipients.

Main Methods:

• A retrospective study included pediatric and adolescent patients who underwent RT between March 2001 and August 2014.
• Patients were categorized into living related donor (LRD) and deceased donor (DD) groups.
• Data on cold ischemic time, infections, rejection, and graft survival were analyzed.

Main Results:

• Prolonged cold ischemia (>13 hours) correlated with delayed graft function (P=.029).
• Infections, particularly urinary tract infections (UTIs), were highly prevalent (90.7%).
• Graft survival rates at 1, 3, and 5 years were comparable between LRD and DD groups (e.g., 85.7% vs. 81.8% at 5 years).
• Recurrent UTIs and cytomegalovirus (CMV) infections negatively affected 1-year graft function (P<.05).
• Rejections, bladder dysfunction, and older donor age (≥50 years) were linked to graft deterioration at 3 years (P<.01).

Conclusions:

• Pediatric renal transplantation in Thailand demonstrates favorable graft and patient survival rates.
• While infections impact early graft function, they do not significantly affect long-term graft and patient survival.
• Identifying and managing risk factors like prolonged cold ischemia and specific infections is crucial for optimizing pediatric RT outcomes.