Acute Rejection Is a Strong Negative Predictor of Graft Survival in Living-Donor Pediatric Renal Transplant: 10-Year Follow-Up in a Single Mexican Center

Objectives: Kidney transplant is the optimal treatment for children with end-stage renal disease. Multiple factors affect patient and graft survival. We assessed determinants of long-term patient/graft survival in our center by a retrospective review of pediatric living donor (< 18 years) kidney transplants from February 2003 to December 2016. Materials and Methods: Donor and recipient demo graphic data and immunosuppression use were gathered for analyses. Transplant outcomes included patient/graft survival, acute rejection, and 1-year estimated glomerular filtration rate. Patient/graft survival results were analyzed by Kaplan-Meier, and Cox proportional hazards regression model was used for risk factors (univariate/multivariate). P <= .05 was statistically significant. Results: Ninety-nine patients were included. Age was 13.4 +/- 3.08 years, 64.6% were male, and 88.9% were on dialysis with time of 17.1 +/- 12.6 months. Mean donor age was 36.6 +/- 7.7 years, and most were females (63.6%). Donor estimated glomerular filtration rate was 89.4 +/- 16.9 mL/min/1.73 m(2). HLA match was 3.2 +/- 1.05. Panel reactive antibody showed 8.6 +/- 20.5%. Of total patients, 47.5% used induction, 88.9% used cyclo sporine, and 100% used mycophenolate mofetil. Five-and 10-year patient survival rates were 93.2% and 93.2%. One-year acute rejection was 14.1%, with rate of 24.2% throughout follow-up. One-year estimated glomerular filtration rate was 76.4 +/- 25.6 mL/min/1.73 m(2). Five- and 10-year graft survival rates were 62.6% and 43.3%. Multivariate analysis confirmed donor age and acute rejection episodes throughout follow-up as risk factors for graft survival (P < .05). Conclusions: Acute rejection and donor age are important risk factors for 10-year graft survival in living-donor pediatric kidney transplant in our program.