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Predictive Factors of Renal Graft Failure in Tunisian Children and young adults: A Retrospective Study
Abir Boussetta1,2, Manel Jellouli1,2, Tahar Gargah1,2
1Pediatric nephrology department, Charles Nicolle Hospital, Tunis, Tunisia.
Insights
Identifying predictive factors for kidney graft failure in pediatric patients is crucial for improving long-term outcomes in renal transplantation. This study highlights key indicators influencing graft survival in young Tunisian recipients.
Area of Science:
- Pediatric Nephrology
- Transplantation Immunology
- Clinical Epidemiology
Background:
- Pediatric end-stage renal disease (ESRD) presents significant challenges, impacting children's quality of life.
- Kidney transplantation is the primary treatment for pediatric ESRD, aiming to restore renal function.
- Graft failure in pediatric kidney transplantation leads to severe complications and reduced survival.
Purpose of the Study:
- To identify factors predicting renal graft failure in Tunisian children and young adults post-kidney transplantation.
- To analyze long-term graft survival rates and associated complications.
- To inform strategies for improving outcomes in pediatric renal transplantation.
Main Methods:
- Retrospective bicentric study of pediatric patients (age ≤ 20 years) undergoing renal transplantation (1989-2019).
- Analysis of long-term graft survival, patient survival, and complications.
- Univariate and multivariate analyses to determine predictive factors for graft survival.
Main Results:
- Graft failure occurred in 30% of 115 kidney transplantations in 112 patients.
- Key predictors of graft failure included specific immunosuppressive regimens, transplant year, donor type, ESRD etiology, rejection episodes, proteinuria, urologic complications, and creatinine levels.
- Overall 1-, 5-, and 10-year graft survival rates were 92%, 85.9%, and 74.5%, respectively.
Conclusions:
- Several factors significantly predict renal graft failure in Tunisian pediatric and young adult kidney transplant recipients.
- Understanding these predictive factors is essential for optimizing post-transplant management and improving graft longevity.
- This research provides valuable insights for clinical practice in pediatric renal transplantation.
Introduction:
Pediatric end-stage renal disease is a rare but severe condition that causes numerous complications and impairs the quality of life of children. Kidney transplantation is the therapy of choice in pediatric end-stage renal disease.
Aim:
Our study aimed to identify the predictive factors of renal graft failure after kidney transplantation in Tunisian children and young adults.
Methods:
We conducted a retrospective bicentric study of children and young adults (age≤20 years) who had undergone renal transplantation between 1989 and 2019 in Tunisia. We analyzed long-term survival rates and complications after pediatric kidney transplantation and searched for predictive parameters for graft dysfunction. We used a univariate and a multivariate analysis to identify predictive factors of graft survival.
Results:
A total of 112 patients underwent 115 kidney transplantations. Graft failure occurred in 30% of the cases. The overall 1-, 3-, 5- and 10-year graft survival rates were 92%, 89.1%, 85.9% and 74.5% respectively. The following parameters strongly influenced graft survival: immunosuppressive regimen including an association other than Mycophenolate mofetil- tacrolimus and corticosteroids (p=0.002), year of transplant (p<0.0001 for 1987-2000), deceased donor (p = 0.039), underlying etiology of end-stage renal disease (p=0.045), occurrence of acute or chronic rejection (p<0.001), a urine protein greater than 0.3 g/l per day (p=0.002), post-transplant urologic complications (p=0.002), five-year creatinine level>1.28 mg/dl (p<0.001). The overall 1-, 3-, 5- and 10-year patients survival rates were 97%, 95%, 90.2% and 84.4% respectively.
Conclusions:
Our study identified several predictive factors of graft failure in Tunisian children and young adults undergoing renal transplantation.
