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Kidney Week

Abstract: FR-PO1195

Non-Preemptive vs. Preemptive "Second" Kidney Transplant with Graft Failure Risk Among Pediatric Kidney Transplant Recipients

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Okuda, Yusuke, Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, United States
  • Rhee, Connie, Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, United States
  • Tantisattamo, Ekamol, Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, United States
  • Laster, Marciana, University of California Los Angeles, Los Angeles, California, United States
  • Tang, Ying, Shengjing Hospital of China Medical University, Shenyang, China
  • Rajpoot, Deepak K., Pediatric Renal Medical Corp, Irvine, California, United States
  • Molnar, Miklos Zsolt, University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Ichii, Hirohito, University of California Irvine, Huntington Beach, California, United States
  • Obi, Yoshitsugu, Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, United States
  • Kalantar-Zadeh, Kamyar, Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, United States
  • Streja, Elani, Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, United States
Background

Preemptive kidney transplant may have a graft survival benefit for the first kidney transplant among children. However, its benefit is less clear for subsequent transplantation after allograft failure. This study aimed to evaluate the graft failure risk associated with nonpreemptive (vs. preemptive) second kidney transplant among pediatric recipients.

Methods

In a cohort of pediatric kidney transplant recipients who underwent a second kidney transplant by the age of 21 years old between 1987 and 2016 from the United States Renal Data System, we examined the association of nonpreemptive (vs. preemptive) second transplant with risk for second graft failure, using a Cox proportional hazards regression in case mix, transplant data, and fully (transplant data plus preemptive first transplant, first graft survival time and total duration of receiving renal replacement therapy) adjusted models.

Results

Among 2,860 included patients, the median age at the second transplant was 16 (interquartile range: 12–19) years old, and 481 (17%) underwent a preemptive transplant. A total of 1,351 graft failures were observed during a total follow-up of 14,960 patient-years (median 4.8 years). Nonpreemptive had higher graft failure risk [Figure A]. In the fully adjusted Cox model, hazard ratio (HR) for the nonpreemptive group was 1.43 (95%CI, 1.18–1.72). In subgroup analysis by the first graft survival time, the fully adjusted HRs (95%CIs) for the nonpreemptive group were 4.04 (1.38–11.80), 1.15 (0.80–1.66), 1.23 (0.88–1.71), and 1.38 (0.99–1.94) in first graft survival time 0–<1, 1–<12, 12–<60, and ≥60 months, respectively [Figure B].

Conclusion

Nonpreemptive second transplant was associated with higher graft failure risk compared to preemptive transplant. Our results demonstrate the benefit of preemptive second transplant among pediatric kidney transplant recipients.

Funding

  • NIDDK Support