Risk factors associated with allograft failure in pediatric kidney transplant recipients with focal segmental glomerulosclerosis
Background With improved outcomes for children transplanted with FSGS since previous NAPRTCS registry reports, this study re‐evaluates the association of living donation, immunosuppression, and DGF on graft survival. Setting Patients transplanted between 2002 and 2016, comparing FSGS diagnosis vs ot...
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| Veröffentlicht in: | Pediatric transplantation 2019-08, Vol.23 (5), p.e13469-n/a |
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| creator | Koh, Lee Jin Martz, Karen Blydt‐Hansen, Tom David |
| description | Background
With improved outcomes for children transplanted with FSGS since previous NAPRTCS registry reports, this study re‐evaluates the association of living donation, immunosuppression, and DGF on graft survival.
Setting
Patients transplanted between 2002 and 2016, comparing FSGS diagnosis vs other glomerular diseases.
Methods
Primary outcomes were allograft survival and FSGS recurrent‐free graft survival. Potential risk factors were obtained at the time of transplant and up to 30 days post‐transplantation. Analysis considered a priori that DGF may be a proxy for severe FSGS recurrence. Multivariable survival models for outcome were tested for sensitivity without/with DGF to determine features independent of recurrence.
Results
From the larger cohort of 3010 patients, 5‐year graft survival in children with FSGS (n = 455) was worse (74.3%) compared with other glomerular diseases (87.1%, n = 690) (HR 1.45, P = 0.033). Modeling all glomerular diseases, survival risk was associated with deceased donor (HR 1.83, P = 0.002), re‐transplantation (HR 1.58, P = 0.013), and recipient age (HR 1.06/y, P = 0.002). The living donor advantage was not confirmed in a FSGS model (HR 1.51 for deceased, P = 0.12). DGF was highly associated with graft failure (HR 4.39, P |
| doi_str_mv | 10.1111/petr.13469 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2267408993</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2266710996</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3579-ee0f342659f6392eac0705f57146886bb1d942c9a48808c33eba047f56bc23e93</originalsourceid><addsrcrecordid>eNp9kU9rFjEQh4Motr568QNIwEsRtiabbHZzlFL_QEEp9bxks5PXtNnNmslS3psf3bzd6sGDc5khPDzM5EfIa87Oean3C-R0zoVU-gk55ULrSjCpnj7MbSW4rE_IC8RbxriSnXxOTgTnSgvRnpJf1x7vqDM2x4TUIEbrTYaR3vv8g5oQ4j4Zlwvhw5qA-pkuMBYkeUvv_DjDgeZkZlyCmTNNYP3iYc64CVy0JlCE_VTeyrQPcYK0hog2QIro8SV55kxAePXYd-T7x8ubi8_V1ddPXy4-XFVWNK2uAJgTslaNdkroGoxlLWtc03Kpuk4NAx-1rK02sutYZ4WAwTDZukYNthagxY6cbd4lxZ8rYO4njxZCWRviin1dq1ayTpdv2ZG3_6C3cU1z2e5IqZYzrVWh3m2ULXdgAtcvyU8mHXrO-mMu_TGX_iGXAr95VK7DBONf9E8QBeAbcO8DHP6j6r9d3lxv0t8QUZrJ</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2266710996</pqid></control><display><type>article</type><title>Risk factors associated with allograft failure in pediatric kidney transplant recipients with focal segmental glomerulosclerosis</title><source>MEDLINE</source><source>Wiley Online Library Journals Frontfile Complete</source><creator>Koh, Lee Jin ; Martz, Karen ; Blydt‐Hansen, Tom David</creator><creatorcontrib>Koh, Lee Jin ; Martz, Karen ; Blydt‐Hansen, Tom David ; NAPRTCS Registry Investigators ; the NAPRTCS Registry Investigators</creatorcontrib><description>Background
With improved outcomes for children transplanted with FSGS since previous NAPRTCS registry reports, this study re‐evaluates the association of living donation, immunosuppression, and DGF on graft survival.
Setting
Patients transplanted between 2002 and 2016, comparing FSGS diagnosis vs other glomerular diseases.
Methods
Primary outcomes were allograft survival and FSGS recurrent‐free graft survival. Potential risk factors were obtained at the time of transplant and up to 30 days post‐transplantation. Analysis considered a priori that DGF may be a proxy for severe FSGS recurrence. Multivariable survival models for outcome were tested for sensitivity without/with DGF to determine features independent of recurrence.
Results
From the larger cohort of 3010 patients, 5‐year graft survival in children with FSGS (n = 455) was worse (74.3%) compared with other glomerular diseases (87.1%, n = 690) (HR 1.45, P = 0.033). Modeling all glomerular diseases, survival risk was associated with deceased donor (HR 1.83, P = 0.002), re‐transplantation (HR 1.58, P = 0.013), and recipient age (HR 1.06/y, P = 0.002). The living donor advantage was not confirmed in a FSGS model (HR 1.51 for deceased, P = 0.12). DGF was highly associated with graft failure (HR 4.39, P < 0.001) and independent of re‐transplant history but not FSGS diagnosis. Induction agents or primary immunosuppression choices were not associated with survival.
Conclusion
Graft survival rates have improved since the previous report. Living donor did not predict graft failure, but there remains no survival advantage. DGF was the primary independent predictor for graft loss secondary to FSGS recurrence, consistent with DGF being a proxy for severe recurrent disease.</description><identifier>ISSN: 1397-3142</identifier><identifier>EISSN: 1399-3046</identifier><identifier>DOI: 10.1111/petr.13469</identifier><identifier>PMID: 31169337</identifier><language>eng</language><publisher>Denmark: Wiley Subscription Services, Inc</publisher><subject>Adolescent ; Child ; Children ; Diagnosis ; Female ; focal segmental glomerulosclerosis ; FSGS ; Glomerulosclerosis, Focal Segmental - surgery ; Graft Rejection ; Grafts ; Humans ; Immunosuppression ; Kidney Transplantation ; Kidney transplants ; Male ; pediatric kidney transplant ; recurrence of original disease ; Registries ; Renal failure ; Risk Factors ; Survival ; Transplants & implants</subject><ispartof>Pediatric transplantation, 2019-08, Vol.23 (5), p.e13469-n/a</ispartof><rights>2019 Wiley Periodicals, Inc.</rights><rights>2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3579-ee0f342659f6392eac0705f57146886bb1d942c9a48808c33eba047f56bc23e93</citedby><cites>FETCH-LOGICAL-c3579-ee0f342659f6392eac0705f57146886bb1d942c9a48808c33eba047f56bc23e93</cites><orcidid>0000-0002-8864-0197 ; 0000-0002-2161-2845</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fpetr.13469$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fpetr.13469$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27903,27904,45553,45554</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31169337$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Koh, Lee Jin</creatorcontrib><creatorcontrib>Martz, Karen</creatorcontrib><creatorcontrib>Blydt‐Hansen, Tom David</creatorcontrib><creatorcontrib>NAPRTCS Registry Investigators</creatorcontrib><creatorcontrib>the NAPRTCS Registry Investigators</creatorcontrib><title>Risk factors associated with allograft failure in pediatric kidney transplant recipients with focal segmental glomerulosclerosis</title><title>Pediatric transplantation</title><addtitle>Pediatr Transplant</addtitle><description>Background
With improved outcomes for children transplanted with FSGS since previous NAPRTCS registry reports, this study re‐evaluates the association of living donation, immunosuppression, and DGF on graft survival.
Setting
Patients transplanted between 2002 and 2016, comparing FSGS diagnosis vs other glomerular diseases.
Methods
Primary outcomes were allograft survival and FSGS recurrent‐free graft survival. Potential risk factors were obtained at the time of transplant and up to 30 days post‐transplantation. Analysis considered a priori that DGF may be a proxy for severe FSGS recurrence. Multivariable survival models for outcome were tested for sensitivity without/with DGF to determine features independent of recurrence.
Results
From the larger cohort of 3010 patients, 5‐year graft survival in children with FSGS (n = 455) was worse (74.3%) compared with other glomerular diseases (87.1%, n = 690) (HR 1.45, P = 0.033). Modeling all glomerular diseases, survival risk was associated with deceased donor (HR 1.83, P = 0.002), re‐transplantation (HR 1.58, P = 0.013), and recipient age (HR 1.06/y, P = 0.002). The living donor advantage was not confirmed in a FSGS model (HR 1.51 for deceased, P = 0.12). DGF was highly associated with graft failure (HR 4.39, P < 0.001) and independent of re‐transplant history but not FSGS diagnosis. Induction agents or primary immunosuppression choices were not associated with survival.
Conclusion
Graft survival rates have improved since the previous report. Living donor did not predict graft failure, but there remains no survival advantage. DGF was the primary independent predictor for graft loss secondary to FSGS recurrence, consistent with DGF being a proxy for severe recurrent disease.</description><subject>Adolescent</subject><subject>Child</subject><subject>Children</subject><subject>Diagnosis</subject><subject>Female</subject><subject>focal segmental glomerulosclerosis</subject><subject>FSGS</subject><subject>Glomerulosclerosis, Focal Segmental - surgery</subject><subject>Graft Rejection</subject><subject>Grafts</subject><subject>Humans</subject><subject>Immunosuppression</subject><subject>Kidney Transplantation</subject><subject>Kidney transplants</subject><subject>Male</subject><subject>pediatric kidney transplant</subject><subject>recurrence of original disease</subject><subject>Registries</subject><subject>Renal failure</subject><subject>Risk Factors</subject><subject>Survival</subject><subject>Transplants & implants</subject><issn>1397-3142</issn><issn>1399-3046</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kU9rFjEQh4Motr568QNIwEsRtiabbHZzlFL_QEEp9bxks5PXtNnNmslS3psf3bzd6sGDc5khPDzM5EfIa87Oean3C-R0zoVU-gk55ULrSjCpnj7MbSW4rE_IC8RbxriSnXxOTgTnSgvRnpJf1x7vqDM2x4TUIEbrTYaR3vv8g5oQ4j4Zlwvhw5qA-pkuMBYkeUvv_DjDgeZkZlyCmTNNYP3iYc64CVy0JlCE_VTeyrQPcYK0hog2QIro8SV55kxAePXYd-T7x8ubi8_V1ddPXy4-XFVWNK2uAJgTslaNdkroGoxlLWtc03Kpuk4NAx-1rK02sutYZ4WAwTDZukYNthagxY6cbd4lxZ8rYO4njxZCWRviin1dq1ayTpdv2ZG3_6C3cU1z2e5IqZYzrVWh3m2ULXdgAtcvyU8mHXrO-mMu_TGX_iGXAr95VK7DBONf9E8QBeAbcO8DHP6j6r9d3lxv0t8QUZrJ</recordid><startdate>201908</startdate><enddate>201908</enddate><creator>Koh, Lee Jin</creator><creator>Martz, Karen</creator><creator>Blydt‐Hansen, Tom David</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>H94</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-8864-0197</orcidid><orcidid>https://orcid.org/0000-0002-2161-2845</orcidid></search><sort><creationdate>201908</creationdate><title>Risk factors associated with allograft failure in pediatric kidney transplant recipients with focal segmental glomerulosclerosis</title><author>Koh, Lee Jin ; Martz, Karen ; Blydt‐Hansen, Tom David</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3579-ee0f342659f6392eac0705f57146886bb1d942c9a48808c33eba047f56bc23e93</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Adolescent</topic><topic>Child</topic><topic>Children</topic><topic>Diagnosis</topic><topic>Female</topic><topic>focal segmental glomerulosclerosis</topic><topic>FSGS</topic><topic>Glomerulosclerosis, Focal Segmental - surgery</topic><topic>Graft Rejection</topic><topic>Grafts</topic><topic>Humans</topic><topic>Immunosuppression</topic><topic>Kidney Transplantation</topic><topic>Kidney transplants</topic><topic>Male</topic><topic>pediatric kidney transplant</topic><topic>recurrence of original disease</topic><topic>Registries</topic><topic>Renal failure</topic><topic>Risk Factors</topic><topic>Survival</topic><topic>Transplants & implants</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Koh, Lee Jin</creatorcontrib><creatorcontrib>Martz, Karen</creatorcontrib><creatorcontrib>Blydt‐Hansen, Tom David</creatorcontrib><creatorcontrib>NAPRTCS Registry Investigators</creatorcontrib><creatorcontrib>the NAPRTCS Registry Investigators</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Pediatric transplantation</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Koh, Lee Jin</au><au>Martz, Karen</au><au>Blydt‐Hansen, Tom David</au><aucorp>NAPRTCS Registry Investigators</aucorp><aucorp>the NAPRTCS Registry Investigators</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Risk factors associated with allograft failure in pediatric kidney transplant recipients with focal segmental glomerulosclerosis</atitle><jtitle>Pediatric transplantation</jtitle><addtitle>Pediatr Transplant</addtitle><date>2019-08</date><risdate>2019</risdate><volume>23</volume><issue>5</issue><spage>e13469</spage><epage>n/a</epage><pages>e13469-n/a</pages><issn>1397-3142</issn><eissn>1399-3046</eissn><abstract>Background
With improved outcomes for children transplanted with FSGS since previous NAPRTCS registry reports, this study re‐evaluates the association of living donation, immunosuppression, and DGF on graft survival.
Setting
Patients transplanted between 2002 and 2016, comparing FSGS diagnosis vs other glomerular diseases.
Methods
Primary outcomes were allograft survival and FSGS recurrent‐free graft survival. Potential risk factors were obtained at the time of transplant and up to 30 days post‐transplantation. Analysis considered a priori that DGF may be a proxy for severe FSGS recurrence. Multivariable survival models for outcome were tested for sensitivity without/with DGF to determine features independent of recurrence.
Results
From the larger cohort of 3010 patients, 5‐year graft survival in children with FSGS (n = 455) was worse (74.3%) compared with other glomerular diseases (87.1%, n = 690) (HR 1.45, P = 0.033). Modeling all glomerular diseases, survival risk was associated with deceased donor (HR 1.83, P = 0.002), re‐transplantation (HR 1.58, P = 0.013), and recipient age (HR 1.06/y, P = 0.002). The living donor advantage was not confirmed in a FSGS model (HR 1.51 for deceased, P = 0.12). DGF was highly associated with graft failure (HR 4.39, P < 0.001) and independent of re‐transplant history but not FSGS diagnosis. Induction agents or primary immunosuppression choices were not associated with survival.
Conclusion
Graft survival rates have improved since the previous report. Living donor did not predict graft failure, but there remains no survival advantage. DGF was the primary independent predictor for graft loss secondary to FSGS recurrence, consistent with DGF being a proxy for severe recurrent disease.</abstract><cop>Denmark</cop><pub>Wiley Subscription Services, Inc</pub><pmid>31169337</pmid><doi>10.1111/petr.13469</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0002-8864-0197</orcidid><orcidid>https://orcid.org/0000-0002-2161-2845</orcidid></addata></record> |
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| ispartof | Pediatric transplantation, 2019-08, Vol.23 (5), p.e13469-n/a |
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| source | MEDLINE; Wiley Online Library Journals Frontfile Complete |
| subjects | Adolescent Child Children Diagnosis Female focal segmental glomerulosclerosis FSGS Glomerulosclerosis, Focal Segmental - surgery Graft Rejection Grafts Humans Immunosuppression Kidney Transplantation Kidney transplants Male pediatric kidney transplant recurrence of original disease Registries Renal failure Risk Factors Survival Transplants & implants |
| title | Risk factors associated with allograft failure in pediatric kidney transplant recipients with focal segmental glomerulosclerosis |
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