Factors related to long-term renal transplant function in children

Short-term renal allograft survival in children has improved. It is therefore important to determine the factors leading to long-term graft function. To this end, we evaluated patients in the NAPTRCS registry who were <12 years old when they received their renal transplant between 1987 and 1993. Children with 10 years of post-transplant follow-up were compared to those in whom the transplant failed within 10 years. Children with a failed transplant within 10 years of the surgery tended to be older, female, and non-Caucasian; they also manifested obstructive uropathy less often and had focal segmental glomerulosclerosis more often, and they received more deceased donor kidneys. Children with a failed renal transplant had fewer HLA donor and recipient matches, received pre-transplant dialysis compared to a preemptive transplant, required dialysis in the first week post-transplant, and required more antihypertensives the first month post-transplant. Allograft function was examined at 10 years. Patients with continued allograft function and a serum creatinine ≤2 mg/dl at 10 years tended to be female and younger, received a younger donor kidney, and received a primary transplant. Serum creatinine, estimated glomerular filtration rate, weight Z score at 10 years, azathioprine use at 10 years, and antihypertensive use at transplant significantly predicted allograft function beyond 10 years. Pediatric transplant physicians should optimize the factors associated with improved long-term allograft function.