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Background Nonadherence to posttransplant immunosuppressive medication is associated with increased rates of rejection and graft loss, yet it is unknown to what degree ideal adherence is associated with the sequelae of overimmunosuppression. Specifically, we questioned whether excellent adherence increased the posttransplant cancer risk. Methods Between August 1998 and August 2006, 195 consenting kidney transplant recipients had electronic monitoring of theirimmunosuppressive medication adherence. Results Based on their average quantitative adherence to a single immunosuppressant drug over the first 6 months posttransplant, recipients were grouped into adherence tertiles (highest, >97.9% adherence; middle, 91–97.8%; lowest, <91%). The cumulative incidence of cancer was calculated for patients in each tertile, treating death as a competing risk. The association between adherence and cancer rate was calculated after adjusting for recipient risk factors, using a competing risk proportional hazards model. The median duration of follow-up was 10.1 years. The 10-year estimated cumulative cancer incidence was 59.4% in the most adherent, 36.1% in the middle group and 38.1% in the least adherent group (P = 0.006). Excluding nonmelanocytic skin cancers, cancer incidence remained significantly higher in the highest adherence group (P = 0.002). Conclusions These data provide additional support for the need to individualize immunosuppression to minimize both rejection and immunosuppressive drug–related complications including cancer. [ABSTRACT FROM AUTHOR]

Temporal changes in kidney transplant outcomes for cystinosis are unknown. We used the SRTR to identify all kidney transplants performed for cystinosis in patients younger than 31 years between 1987 and 2017. We divided time into three equal eras (1987‐1997, 1998‐2007, and 2008‐2017) to assess changes in outcomes using Cox proportional and linear regression models. We examined 441 transplants in 362 patients. Age at ESRD progressively increased (12.1 vs 13.3 vs 13.4; P = .046). Eras 2 and 3 had lower risk of acute rejection (aHR 2 vs 1:0.45; P < .001) (aHR 3 vs 1:0.26; P < .001) and higher 5‐year mean GFR (difference 2 vs 1:9.2 mL/min/1.73 m2; P = .005) (difference 3 vs 1:12.9 mL/min/1.73 m2; P = .002) compared with era 1. Five‐year graft survival was similar across eras, but 5‐year patient survival was higher for era 2 (aHR: 0.25; P = .01). Seventy‐nine patients underwent retransplantation. Five‐year patient (94.2% vs 92.5%; P = .57) and graft survival (79.1% vs 74.1%; P = .52) were similar between primary and subsequent transplants. Age at ESRD, acute rejection, GFR at 5 years, and patient survival improved over time. Kidney retransplantation is associated with excellent outcomes in children and young adults with cystinosis. [ABSTRACT FROM AUTHOR]

Background: KT recipients have increased the risk of CVD. The incidence of post‐transplant CVEs among pediatric recipients has not been well‐characterized. Patients and Methods: Between 1963 and 2015, 884 pediatric (age: 0‐17 years old) recipients received 1058 KTs at our institution. The cumulative incidence of CVEs was analyzed. Statistical models were used to estimate risk factors for developing post‐transplant CVEs. Results: Overall median patient survival was 33 years (IQR: 18.7‐47). A total of 362 CVEs occurred in 161 (18.3%) patients at a median age of 20.5 years. Arrhythmias (18%) were most common. Cumulative risk of post‐transplant CVEs was 9% at 10 years, 17% at 20 years, 25% at 30 years, and 36% at 40 years. Development of post‐transplant CVEs was associated with increased mortality (HR 2.25 [95% CI 1.61‐3.14]); of those who developed a CVE and died, 22/51 (43.1%) died of CVD. Multivariable risk factors for post‐transplant CVEs included a history of pretransplant CVD (aHR 1.92 [1.18‐3.13] and graft failure (4.57 [3.13‐6.67]). Discussion: A pretransplant history of CVD and a failed graft are significant risk factors for the development of post‐transplant CVE. CVD increases the risk of post‐transplant death or graft loss. [ABSTRACT FROM AUTHOR]