Poster 18. Graft failure by rejection in adolescent kidney transplant recipients

Thursday 14 march 2019

12:36 - 12:39h

Categories: Klinisch, Postersessie

Parallel session: Postersessies 4 - Clinical

F.H.M. Vrieling-Prince1, J.I. Roodnat2, M.C. Clahsen-van Groningen3, H. de Jong1, K. Cransberg1

1Dept. of Paediatric Nephrology, Erasmus MC - Sophia Children's Hospital, Rotterdam,The Netherlands2Dept. of Nephrology & Transplantation, Erasmus University Medical Center, Rotterdam,The Netherlands3Dept. of Pathology, Erasmus University Medical Center, Rotterdam, The Netherlands.

Background: Several registries report a high risk of graft loss in kidney transplantation during adolescence. We hypothesize that this high risk is associated with an active immune system during puberty. In the current study we evaluate episodes of acute rejection and causes of graft loss in patients of different age groups. The aim is to study if adolescents have a higher risk of acute rejection and (early) graft loss due to acute or chronic rejection.

Methods: We performed a retrospective single center study in kidney transplant recipients, receiving their first graft between 1990 and 2018, at age 6-25. Exclusion: ABOI and living unrelated donation including cross-over and altruist donation. Electronic patient files were searched for all for-cause graft biopsy reports, and for date and cause of graft failure and/or death. A graft biopsy reporting positive signs of active rejection is defined an acute rejection episode (ARE). Definition of graft failure by active and/or chronic rejection as indicated in the Eurotransplant registry.

Results: We included 250 kidney transplant recipients, 120 pediatric (46% living donor) and 130 adult patients (83% living donor). In 54% of the pediatric and 65% of adult patients at least one for-cause graft biopsy was obtained. Sixty seven patients had signs of ARE in at least 1 biopsy, with the highest incidence in the age 20-25 years group (27%, n=20) and the lowest in the age 6-10 years group (16%, n=5). ARE-free survival was best in the youngest group (6-10 years, n=32), at 2 years post-transplant 90% and at 8 years 86%; followed by the 10-15 years old (n=49) 86% and 81%. The older recipients showed a higher incidence of AREs, with a ARE-free survival in 15-20 years old (n=94) of 86% and 68% at 2 and 8 years post-transplant, and in 20-25 years old (n=75) of 84% and 65% respectively (log rank p=0.063). Subsequently graft losses due to active and/or chronic rejection were studied. Graft survival was best in the 6-10 years old: at 2 years post-transplant 97% and 8 years post-transplant 89%; followed by the 20-25 years old: 97% and 85%. Worst graft survival was seen in the middle groups: in 10-15 years old 96% and 67%; and in 15-20 years old 93% and 67% respectively (log rank p=0.073).

Conclusions: The oldest kidney transplant recipients showed the highest incidence of ARE. The worst graft survival due to active and/or chronic rejection was seen in the adolescent groups, as we expected. The differences between the age groups only showed a trend in significance.