Infant kidney transplants have a higher graft failure rate in first year, study shows

31
3
Infant kidney transplants have a higher graft failure rate in first year, study shows

California January 15, ANI A new study shows improved outcomes for children with kidney disease who receive transplants as infants.

Infant kidney transplants comprise a small portion of all paediatric kidney transplants in the U.S. Since January 1, 2000, the Organ Procurement and Transplantation Network OPTN database reported that fewer than half of 1 percent of all kidney transplants were infants.

Care providers often wait for an infant to grow larger because of the technical challenges of performing this surgery on a small recipient. Most people prefer to put infants on dialysis in the hopes of improving patient survival odds and limiting graft failure, which is when the body rejects the transplanted organ.

The study found that an infant kidney transplant has a higher graft failure rate in the first year than preteen and teen kidney transplants. After the first year, the graft failure rates in infant kidney transplants are comparable or even lower.

If kidney transplants take place earlier, the adverse effects of kidney failure can be avoided. They include the impacts on neurodevelopmental outcomes and growth, as well as the significantly higher risk of cardiovascular morbidity and mortality during dialysis in this vulnerable group.

Our study shows that infants with advanced chronic kidney disease, one of the most vulnerable of all kidney patients, have much to benefit from receiving kidney transplants and can do so safely and with excellent long-term outcomes, in an experienced transplant centre, said Lavjay Butani, senior author of the study and chief of pediatric nephrology at UC Davis Children's Hospital. Daniel Tancredi, professor of pediatrics at the UC Davis School of Medicine, was the lead author of the study.

The study looked at 2,696 paediatric kidney transplant patients who had their first kidney transplant between Jan. 1, 2000 and December 31, 2015. Of these patients, 27 were infant recipients. The study excluded recipients who had a graft failure on the day of their transplant.

The study found that the number of infant kidney transplants remained constant for three paediatric age categories, based on their age at the time of transplant: infants 1 year and younger preteens ages 1 to 11 and teenagers ages 12 to 17. The results also showed that the number of infant kidney transplants in many years remained the same, ranging from zero in many years to a peak of five in 2006. There was no change in the number of infant kidney transplants over time.

The infant recipients were more likely to be male, have structural causes of chronic kidney failure and have hypoalbuminemia, a low level of albumin protein in the blood.

Before their transplant, the majority of infant and paediatric kidney recipients had experienced a period of dialysis.

The highest graft failure rates were seen in the first year after transplant: 10.4 per cent of infants compared to 3.8 per cent of preteens and teens. These failure rates declined over time. Five years after transplant, 16.4 percent of infants, 13.6 percent of preteens and 19.9 percent of teens had graft failures.

The study said that kidney transplants should be performed in experienced centers like UC Davis Children's Hospital to minimize risk. The data from the OPTN database shows that kidney transplants were concentrated in a few geographic areas, reflecting the comfort level and expertise of just a few transplant teams that perform kidney transplants on infants.