ESPU Congress 2018 - Abstract Book

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130 29th CONGRESS OF THE ESPU
13:36–13:39
S16-3 (PP)
PAEDIATRIC KIDNEY TRANSPLANTATION: IMPACT
OF DONOR AGE, HLA MATCH, PRA AND PTLD
Anja LINGNAU1 , Beatriz BAÑUELOS MARCO1, Therese-Marie KOCH2 and Dominik
MÜLLER2
1) Charité-Universitätsmedizin Berlin, Paediatric Urology, Berlin, GERMANY - 2) Charité-Universitätsmedizin Berlin,
Paediatric Nephrology, Berlin, GERMANY
PURPOSE
Renal transplantation remains the treatment of choice for children with end stage renal disease
(ESRD).
Since children who receive kidney transplants have a long life expectancy it is particularly important
to maximize graft function and graft survival in this population.
The aim of this study was to identify factors associated with both favorable and poor outcomes.
MATERIAL AND METHODS
Our database included 143 paediatric renal transplants up to 21 years of age from January 1997 to
December 2013.
We evaluated patients and donors demographic data, number of transplants, HLA-A, B and DR
mismatch, infectious parameters such as EBV status, pre-transplant transfusions, transplant status
(high-urgency) immunosuppressive therapy, rejection episodes, PRA(pre- and post-transplantation).
RESULTS
Graft survival rates were 92.2 %,85.5 %,71.1 % and 62.1 % after 1,5,10 and 15 years respectively.
Chronic rejections were the leading cause of graft loss (42.9 %).
Overall Survival was 99.3 %, 95.2 %, 94.2 %. 90.7 % after 1,5,10 and 15 years respectively. Re-
transplantation (p=0.022) and Post-Transplant-Lymphoproliferative-Disorders (PTLD)(p=0.002) are
significant parameters for patient survival.
Cox regression analysis showed that the number of HLA-DR mismatches (0–5 vs 6–10) were not
associated with lower graft survival (p=0,186).
Survival graft rates using donors aged,<10, 10–39, 40–59 or >60 years were statistically significant
(log rank p<0,001).
PRA were performed in 40 patients (28 %) post- transplantation and showed association with lower
graft survival (p<0,001).
CONCLUSIONS
We recommend that kidneys from deceased donors up to 59 years be allocated to children, an ac-
ceptable HLA-A_B_DR match be attempted in patients with relatively common HLA phenotypes to
reduce the risk of posttransplant non-Hodgkin lymphoma, which remains one of the most important
mortality factors.
To conclude, PRA is an essential test for the work-up of ESRD patients and may be used for
monitoring of sensitization. PRA levels may be determined by the individual's own immunogenicity
in addition to the well-documented causes.
13:39–13:51
Discussion