Abstract: SA-PO0696
Outcomes in Adolescents and Young Adults with Kidney Transplants: A United States Renal Data System Registry Study
Session Information
- Pediatric Nephrology: Transplantation, Hypertension, AKI, Genetics, and Developmental Diseases
November 08, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Pediatric Nephrology
- 1900 Pediatric Nephrology
Authors
- Raina, Manya, Hathaway Brown School, Shaker Heights, Ohio, United States
- Shah, Raghav, Northeast Ohio Medical University, Rootstown, Ohio, United States
- Hu, Jieji, Northeast Ohio Medical University, Rootstown, Ohio, United States
- Verghese, Priya S., Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois, United States
Background
In adolescent and young adults (AYA) with end-stage kidney disease (ESKD), renal transplantation is the ideal treatment. However, vulnerable individuals between ages 17-25 are described as having a “high-risk window,” where graft loss is 20% more likely to occur, primarily attributed to medication nonadherence and is likely influenced by demographic differences. This study examines the relationship between age, transition of care, and graft outcomes in AYA with ESKD to optimize care and improve success in kidney transplantation.
Methods
Data from the United States Renal Data System (USRDS) was utilized to identify patients. The inclusion criteria consisted of diagnosis of ESKD patients whose first transplant occurred in the year 2000 or later, and who are either adolescents (14–18 years of age) or young adults (19–25 years).
Results
The proportion of patients who were ever wait-listed and who received a transplant was significantly higher among 14-18 years as compared with 19–25 year-old patients (Table 1). For young adults, adjusted 1-year graft survival for living donor transplants peaked at 98.2%, 1-Year Graft Survival - Deceased Donor peaked at 94%, 5-Year Graft Survival - Living Donor peaked at 88.5%, 5-year Graft Survival for deceased Donor peaked at 78.2%, and 3-Year Graft Failure Rate - Living Donor peaked at 3%.
Conclusion
Although adolescents had earlier access to transplant, they had higher rates of first transplant failure and earlier graft loss compared to young adults. There is a need for targeted long-term support to minimize immunosuppression-related complications in this age group. Future efforts must target the barriers faced by AYA to enhance graft survival and optimize outcomes.
Initial kidney transplant data for adolescents and young adult patients
| 14 - 18 years [n=6,043] | 19 - 25 years [n=7,092] | Total [n=13,135] | p value | |
| Age at first transplant [years]* | 18 (2.4) | 23.4 (1.8) | 20.9 (3.4) | |
| First transplant donor type | ||||
| - Deceased donor | 2307 (38.18%) | 4661 (65.72%) | 6968 (53.1%) | <0.0001 |
| - Living | 1 (0.02%) | 2 (0.03%) | 3 (0.01%) | |
| - Missing | 3735 (61.81%) | 2429 (34.25%) | 6164 (46.9%) | |
| First transplant failure | ||||
| - No | 4439 (73.5%) | 5630 (79.4%) | 10069 (76.66%) | <0.0001 |
| - Yes | 1604 (26.5%) | 1462 (20.6%) | 3066 (23.34%) | |
| Age at first transplant failure [years]* | 23.3 (4.2) | 28.8 (4.7) | 25.9 (5.2) | |
| Time to first transplant failure [years]* | 5.0 (3.8) | 5.4 (4.3) | 5.3 (4.1) | <0.0001 |
| Survival time after first transplant [years]^* | 7.4 (4.4) | 7.2 (4.6) | 7.8 (4.3) | 0.413 |
| Mortality in transplanted Patients | 590 (9.76%) | 721 (10.17%) | 1311 (9.98%) | 0.448 |
^Reported for 905 subjects *Reported as mean (SD); rest all as n (%)