Pediatric kidney transplantation: Experience of 25 years in a high complexity hospital of Colombia
Jaime Restrepo1, Hernando Londoño1, Ana M. Aristizabal3, Vanessa Ochoa1, Jessica Forero1, Eliana Manzi5, Ana M. Arrunategui4, Luis A. Caicedo2, Karen Molina3, Elena M. Useche5, Kevin A. Villa3, Juan D. Riaño3.
1Pediatric Nephrology service, Fundación Valle del Lili, Cali, Colombia; 2Solid organ Trasplant service , Fundación Valle del Lili, Cali, Colombia; 3Health science department, Universidad Icesi, Cali, Colombia; 4Pathology service, Fundación Valle del Lili, Cali, Colombia; 5Clinical research center, Fundación Valle del Lili, Cali, Colombia
Introduction: This study sought to report 25 years of experience in pediatric kidney transplantation in Colombia. The study describes the clinical outcomes and risk factors for graft loss of pediatric kidney transplantation, graft, and patient survival in Colombia.
Materials and methods: This retrospective cohort study describes clinical and paraclinical features in pediatric patients with kidney transplantation in a hospital in Colombia between 1995 and 2020. We used median for continuous variables, proportions for qualitative variables, and Kaplan-Meier curve to describe the patient's survival, graft, and acute rejection. Cox regression was used to identify risk factors for graft loss.
Results: Between 1995 and 2020, 184 pediatric kidney transplants were performed. 15% of patients did not require pre-transplant dialysis. 51,7% of patients had CKD caused by CAKUT. The median age at transplant was 12 (9-15) years; 52,7% were living donors. The most frequent immunosuppression treatment was Induction + TMP (tacrolimus + mycophelonate Mofetil and prednisone) 61% and without induction, CMP (cyclosporine + mycophelonate Mofetil and prednisone) 24%. Acute rejection analysis was performed for periods according to treatment: CAP (cyclosporine + azathioprine and prednisone), CMP, TMP whit induction different to thymoglobulin and TMP whit induction whit thymoglobulin the incidence in 12 months was 20%, 29%, 18%, and 14%, respectively (p=0.3532). Graft survival at 1, 5, 10, 15, 20 and 25 years were 88%, 74%, 63%, 54%, 43% and 43% and the patient survival were 96%, 94%, 93%, 93% and 93. Use of Thymoglobulin-Induction+TMP was a HR=0.37 (IC95%: 0.2-0.8; p=0.018) for graft loss.
Conclusion: Renal transplantation is considered the best treatment option for patients with CKD. In this patients group, the use of thymoglobulin-Induction+TMP had a protective factor for graft loss. Acute rejection was a risk factor for graft loss.