Long-Term Clinical Outcomes of Paediatric Kidney Transplantation in Hong Kong-A Territory-Wide Study

To review the clinical characteristics and long-term outcomes of paediatric kidney transplants in Hong Kong.

A retrospective cohort study was carried out on all paediatric kidney transplant recipients managed in the Paediatric Nephrology Centre in Hong Kong from 2009 to 2020. All recipients were under 21 at the time of transplant, with a minimal follow-up period of 2 years.

Sixty-one patients (57.4% male; median age 13 years, IQR: 8.9-17.8) were followed for 6.4 years (IQR 4.3-9.6). The commonest causes of kidney failure were congenital abnormalities of the kidney and urinary tract (34.4%), followed by glomerular diseases (21.3%). 90.2% were deceased donor transplantation. Patient survival rates were 100%, 96.4%, and 96.4% at 1, 5, and 7 years, respectively, and the corresponding graft survival rates were 95.1%, 95.1%, and 89.9%. There were eight graft losses (13.1%). Rejection and chronic allograft nephropathy were the leading causes for graft loss after the first month. Donor age at or above 35 years and the presence of donor-specific antibodies with a history of antibody-mediated rejection (both p < 0.05) were associated with worse graft survival, while medication non-adherence was associated despite being marginally significant (p = 0.056). The rates of CMV syndrome and biopsy-proven BKV nephropathy were 19.7% and 13.1% respectively. 47.5% had short stature at the last follow-up.

Our paediatric kidney transplantation outcomes are favourable and comparable to international benchmarks. Preferential allocation of young donors below 35 to paediatric recipients, reinforce immunosuppressant compliance and early detection of DSA with prompt treatment of ABMR may improve allograft outcomes in paediatric recipients.