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Late first acute rejection in pediatric kidney transplantation: A North American Pediatric Renal Trials and Collaborative Studies special study
- Source :
- Pediatric Transplantation. 25
- Publication Year :
- 2020
- Publisher :
- Wiley, 2020.
-
Abstract
- Rates of early AR in pediatric kidney transplantation have declined in every era but the most recent NAPRTCS cohort has shown an increase in late first AR rates. We hypothesized this was due to an increased proportion of deceased donor utilization and early steroid taper utilization. Using the NAPRTCS database, we compared the most recent three cohorts of patients transplanted between 2002-2006, 2007-2011, and 2012-2017. To determine variables that predict late first AR, we used two multivariable models: a standard Cox regression model and LASSO model. From the LASSO model, deceased donor source (P = .002), higher recipient age (P = .019), black race (P = .010), and transplant cohort 2012-17 (P = .014) were all significant predictors of more late first AR. On standard Cox regression analysis, those same variables, minus donor source, were significant, in addition to mycophenolates usage (P = .007) and lower eGFR at 12 months (P = .02). The most recent 2012-2017 cohort remains an independently significant risk factor for late first AR, suggesting unmeasured variables. Further research is needed to determine whether these higher late first AR rates will impact long-term graft survival in the most recent cohort.
- Subjects :
- Graft Rejection
Male
medicine.medical_specialty
Time Factors
Adolescent
030232 urology & nephrology
Kaplan-Meier Estimate
030230 surgery
Black race
Donor Selection
03 medical and health sciences
0302 clinical medicine
Risk Factors
Internal medicine
medicine
Humans
Significant risk
Child
Kidney transplantation
Proportional Hazards Models
Retrospective Studies
Transplantation
Deceased donor
Proportional hazards model
business.industry
Infant, Newborn
Infant
medicine.disease
Kidney Transplantation
Renal transplant
Child, Preschool
North America
Pediatrics, Perinatology and Child Health
Cohort
Linear Models
Female
Graft survival
business
Follow-Up Studies
Subjects
Details
- ISSN :
- 13993046 and 13973142
- Volume :
- 25
- Database :
- OpenAIRE
- Journal :
- Pediatric Transplantation
- Accession number :
- edsair.doi.dedup.....75b6c3af26707342943ad6ce092e78dd