Late first acute rejection in pediatric kidney transplantation: A North American Pediatric Renal Trials and Collaborative Studies special study
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 NAPRT...
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| Veröffentlicht in: | Pediatric transplantation 2021-08, Vol.25 (5), p.e13953-n/a |
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| creator | Barton, Kevin T. Halani, Khalif Galbiati, Shirley Dandamudi, Raja Hmiel, Stanley Paul Dharnidharka, Vikas R. Somers, Michael Chua, Annabelle Barcia, John Hooper, David Barletta, Gina‐Marie Turman, Martin Belsha, Craig Harvey, Elizabeth Salusky, Isidro Yadin, Ora Lee, Marsha Langman, Craig Atkinson, Meredith Greenbaum, Laurence Warady, Bradley Bartosh, Sharon Seikaly, Mouin Zahr, Rima Blydt‐Hansen, Tom Lovell, Helen Rheault, Michelle Kumar, Juhi Lee‐Son, Kathy Benador, Nadine Arar, Mazen DeFreitas, Marissa Luckritz, Kera Fathallah‐Shaykh, Sahar Flynn, Joseph Raina, Rupesh Pan, Cynthia Patel, Hiren Kapur, Gaurav Czech, Kimberly Cramer, Carl Sharma, Amita Lerner, Gary Grushkin, Carl Dharnidharka, Vikas Chen, Ashton Bock, Margret Moudgil, Asha Blaszak, Richard Pal, Abhijeet Nelson, Raoul Richardson, Kelsey Rio, Marcela Del Sahney, Shoba Sheth, Rita Kees‐Folt, Deborah Shah, Siddarth Dell, Katherine Srivaths, Poyyapakkam Twichell, Sarah Hunt, Elizabeth Andreoli, Sharon Gorman, Gregory Puliyanda, Dechu Laskin, Benjamin Zaritsky, Joshua Mathias, Robert Wong, Cynthia Massengill, Susan Woroniecki, Robert Pinsk, Maury Brophy, Patrick Aviles, Diego Bell, Lorraine Staples, Amy Pillutla, Kartik Lieberman, Kenneth Feber, Janusz Al‐Akash, Samhar Ramirez, Jorge Benfield, Mark McKenney, Daniel Constantinescu, Alexandru Pena, Deogracias Quiroga, Alejandro Steinke, Julia |
| description | 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. |
| doi_str_mv | 10.1111/petr.13953 |
| format | Article |
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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.</description><identifier>ISSN: 1397-3142</identifier><identifier>EISSN: 1399-3046</identifier><identifier>DOI: 10.1111/petr.13953</identifier><identifier>PMID: 33350558</identifier><language>eng</language><publisher>Denmark: Wiley Subscription Services, Inc</publisher><subject>acute rejection ; Adolescent ; Child ; Child, Preschool ; Clinical trials ; Donor Selection - methods ; Donor Selection - trends ; Female ; Follow-Up Studies ; Graft rejection ; Graft Rejection - epidemiology ; Graft Rejection - etiology ; Humans ; Infant ; Infant, Newborn ; Kaplan-Meier Estimate ; Kidney Transplantation ; Kidney transplants ; Linear Models ; Male ; North America ; outcome ; pediatric ; Pediatrics ; Proportional Hazards Models ; Regression analysis ; renal transplant ; Retrospective Studies ; Risk Factors ; Time Factors ; Transplants & implants</subject><ispartof>Pediatric transplantation, 2021-08, Vol.25 (5), p.e13953-n/a</ispartof><rights>2020 Wiley Periodicals LLC</rights><rights>2020 Wiley Periodicals LLC.</rights><rights>2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3573-5cf47e5d02c90b1f2e66c1f12bb831afd6a186a3a07788d4a233e88318c3d9d93</citedby><cites>FETCH-LOGICAL-c3573-5cf47e5d02c90b1f2e66c1f12bb831afd6a186a3a07788d4a233e88318c3d9d93</cites><orcidid>0000-0001-8000-1385 ; 0000-0001-8345-8604</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.13953$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fpetr.13953$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33350558$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Barton, Kevin T.</creatorcontrib><creatorcontrib>Halani, Khalif</creatorcontrib><creatorcontrib>Galbiati, Shirley</creatorcontrib><creatorcontrib>Dandamudi, Raja</creatorcontrib><creatorcontrib>Hmiel, Stanley Paul</creatorcontrib><creatorcontrib>Dharnidharka, Vikas R.</creatorcontrib><creatorcontrib>Somers, Michael</creatorcontrib><creatorcontrib>Chua, Annabelle</creatorcontrib><creatorcontrib>Barcia, John</creatorcontrib><creatorcontrib>Hooper, David</creatorcontrib><creatorcontrib>Barletta, Gina‐Marie</creatorcontrib><creatorcontrib>Turman, Martin</creatorcontrib><creatorcontrib>Belsha, Craig</creatorcontrib><creatorcontrib>Harvey, Elizabeth</creatorcontrib><creatorcontrib>Salusky, Isidro</creatorcontrib><creatorcontrib>Yadin, Ora</creatorcontrib><creatorcontrib>Lee, Marsha</creatorcontrib><creatorcontrib>Langman, Craig</creatorcontrib><creatorcontrib>Atkinson, Meredith</creatorcontrib><creatorcontrib>Greenbaum, Laurence</creatorcontrib><creatorcontrib>Warady, Bradley</creatorcontrib><creatorcontrib>Bartosh, Sharon</creatorcontrib><creatorcontrib>Seikaly, Mouin</creatorcontrib><creatorcontrib>Zahr, Rima</creatorcontrib><creatorcontrib>Blydt‐Hansen, Tom</creatorcontrib><creatorcontrib>Lovell, Helen</creatorcontrib><creatorcontrib>Rheault, Michelle</creatorcontrib><creatorcontrib>Kumar, Juhi</creatorcontrib><creatorcontrib>Lee‐Son, Kathy</creatorcontrib><creatorcontrib>Benador, Nadine</creatorcontrib><creatorcontrib>Arar, Mazen</creatorcontrib><creatorcontrib>DeFreitas, Marissa</creatorcontrib><creatorcontrib>Luckritz, Kera</creatorcontrib><creatorcontrib>Fathallah‐Shaykh, Sahar</creatorcontrib><creatorcontrib>Flynn, Joseph</creatorcontrib><creatorcontrib>Raina, Rupesh</creatorcontrib><creatorcontrib>Pan, Cynthia</creatorcontrib><creatorcontrib>Patel, Hiren</creatorcontrib><creatorcontrib>Kapur, Gaurav</creatorcontrib><creatorcontrib>Czech, Kimberly</creatorcontrib><creatorcontrib>Cramer, Carl</creatorcontrib><creatorcontrib>Sharma, Amita</creatorcontrib><creatorcontrib>Lerner, Gary</creatorcontrib><creatorcontrib>Grushkin, Carl</creatorcontrib><creatorcontrib>Dharnidharka, Vikas</creatorcontrib><creatorcontrib>Chen, Ashton</creatorcontrib><creatorcontrib>Bock, Margret</creatorcontrib><creatorcontrib>Moudgil, Asha</creatorcontrib><creatorcontrib>Blaszak, Richard</creatorcontrib><creatorcontrib>Pal, Abhijeet</creatorcontrib><creatorcontrib>Nelson, Raoul</creatorcontrib><creatorcontrib>Richardson, Kelsey</creatorcontrib><creatorcontrib>Rio, Marcela Del</creatorcontrib><creatorcontrib>Sahney, Shoba</creatorcontrib><creatorcontrib>Sheth, Rita</creatorcontrib><creatorcontrib>Kees‐Folt, Deborah</creatorcontrib><creatorcontrib>Shah, Siddarth</creatorcontrib><creatorcontrib>Dell, Katherine</creatorcontrib><creatorcontrib>Srivaths, Poyyapakkam</creatorcontrib><creatorcontrib>Twichell, Sarah</creatorcontrib><creatorcontrib>Hunt, Elizabeth</creatorcontrib><creatorcontrib>Andreoli, Sharon</creatorcontrib><creatorcontrib>Gorman, Gregory</creatorcontrib><creatorcontrib>Puliyanda, Dechu</creatorcontrib><creatorcontrib>Laskin, Benjamin</creatorcontrib><creatorcontrib>Zaritsky, Joshua</creatorcontrib><creatorcontrib>Mathias, Robert</creatorcontrib><creatorcontrib>Wong, Cynthia</creatorcontrib><creatorcontrib>Massengill, Susan</creatorcontrib><creatorcontrib>Woroniecki, Robert</creatorcontrib><creatorcontrib>Pinsk, Maury</creatorcontrib><creatorcontrib>Brophy, Patrick</creatorcontrib><creatorcontrib>Aviles, Diego</creatorcontrib><creatorcontrib>Bell, Lorraine</creatorcontrib><creatorcontrib>Staples, Amy</creatorcontrib><creatorcontrib>Pillutla, Kartik</creatorcontrib><creatorcontrib>Lieberman, Kenneth</creatorcontrib><creatorcontrib>Feber, Janusz</creatorcontrib><creatorcontrib>Al‐Akash, Samhar</creatorcontrib><creatorcontrib>Ramirez, Jorge</creatorcontrib><creatorcontrib>Benfield, Mark</creatorcontrib><creatorcontrib>McKenney, Daniel</creatorcontrib><creatorcontrib>Constantinescu, Alexandru</creatorcontrib><creatorcontrib>Pena, Deogracias</creatorcontrib><creatorcontrib>Quiroga, Alejandro</creatorcontrib><creatorcontrib>Steinke, Julia</creatorcontrib><creatorcontrib>NAPRTCS investigators</creatorcontrib><creatorcontrib>the NAPRTCS investigators</creatorcontrib><title>Late first acute rejection in pediatric kidney transplantation: A North American Pediatric Renal Trials and Collaborative Studies special study</title><title>Pediatric transplantation</title><addtitle>Pediatr Transplant</addtitle><description>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.</description><subject>acute rejection</subject><subject>Adolescent</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Clinical trials</subject><subject>Donor Selection - methods</subject><subject>Donor Selection - trends</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Graft rejection</subject><subject>Graft Rejection - epidemiology</subject><subject>Graft Rejection - etiology</subject><subject>Humans</subject><subject>Infant</subject><subject>Infant, Newborn</subject><subject>Kaplan-Meier Estimate</subject><subject>Kidney Transplantation</subject><subject>Kidney transplants</subject><subject>Linear Models</subject><subject>Male</subject><subject>North America</subject><subject>outcome</subject><subject>pediatric</subject><subject>Pediatrics</subject><subject>Proportional Hazards Models</subject><subject>Regression analysis</subject><subject>renal transplant</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Time Factors</subject><subject>Transplants & 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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/0000-0001-8000-1385</orcidid><orcidid>https://orcid.org/0000-0001-8345-8604</orcidid></search><sort><creationdate>202108</creationdate><title>Late first acute rejection in pediatric kidney transplantation: A North American Pediatric Renal Trials and Collaborative Studies special study</title><author>Barton, Kevin T. ; Halani, Khalif ; Galbiati, Shirley ; Dandamudi, Raja ; Hmiel, Stanley Paul ; Dharnidharka, Vikas R. ; Somers, Michael ; Chua, Annabelle ; Barcia, John ; Hooper, David ; Barletta, Gina‐Marie ; Turman, Martin ; Belsha, Craig ; Harvey, Elizabeth ; Salusky, Isidro ; Yadin, Ora ; Lee, Marsha ; Langman, Craig ; Atkinson, Meredith ; Greenbaum, Laurence ; Warady, Bradley ; Bartosh, Sharon ; Seikaly, Mouin ; Zahr, Rima ; Blydt‐Hansen, Tom ; Lovell, Helen ; Rheault, Michelle ; Kumar, Juhi ; Lee‐Son, Kathy ; Benador, Nadine ; Arar, Mazen ; DeFreitas, Marissa ; Luckritz, Kera ; Fathallah‐Shaykh, Sahar ; Flynn, Joseph ; Raina, Rupesh ; Pan, Cynthia ; Patel, Hiren ; Kapur, Gaurav ; Czech, Kimberly ; Cramer, Carl ; Sharma, Amita ; Lerner, Gary ; Grushkin, Carl ; Dharnidharka, Vikas ; Chen, Ashton ; Bock, Margret ; Moudgil, Asha ; Blaszak, Richard ; Pal, Abhijeet ; Nelson, Raoul ; Richardson, Kelsey ; Rio, Marcela Del ; Sahney, Shoba ; Sheth, Rita ; Kees‐Folt, Deborah ; Shah, Siddarth ; Dell, Katherine ; Srivaths, Poyyapakkam ; Twichell, Sarah ; Hunt, Elizabeth ; Andreoli, Sharon ; Gorman, Gregory ; Puliyanda, Dechu ; Laskin, Benjamin ; Zaritsky, Joshua ; Mathias, Robert ; Wong, Cynthia ; Massengill, Susan ; Woroniecki, Robert ; Pinsk, Maury ; Brophy, Patrick ; Aviles, Diego ; Bell, Lorraine ; Staples, Amy ; Pillutla, Kartik ; Lieberman, Kenneth ; Feber, Janusz ; Al‐Akash, Samhar ; Ramirez, Jorge ; Benfield, Mark ; McKenney, Daniel ; Constantinescu, Alexandru ; Pena, Deogracias ; Quiroga, Alejandro ; Steinke, Julia</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3573-5cf47e5d02c90b1f2e66c1f12bb831afd6a186a3a07788d4a233e88318c3d9d93</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>acute rejection</topic><topic>Adolescent</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Clinical trials</topic><topic>Donor Selection - methods</topic><topic>Donor Selection - trends</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Graft rejection</topic><topic>Graft Rejection - epidemiology</topic><topic>Graft Rejection - etiology</topic><topic>Humans</topic><topic>Infant</topic><topic>Infant, Newborn</topic><topic>Kaplan-Meier Estimate</topic><topic>Kidney Transplantation</topic><topic>Kidney transplants</topic><topic>Linear Models</topic><topic>Male</topic><topic>North America</topic><topic>outcome</topic><topic>pediatric</topic><topic>Pediatrics</topic><topic>Proportional Hazards Models</topic><topic>Regression analysis</topic><topic>renal transplant</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Time Factors</topic><topic>Transplants & implants</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Barton, Kevin T.</creatorcontrib><creatorcontrib>Halani, Khalif</creatorcontrib><creatorcontrib>Galbiati, Shirley</creatorcontrib><creatorcontrib>Dandamudi, Raja</creatorcontrib><creatorcontrib>Hmiel, Stanley Paul</creatorcontrib><creatorcontrib>Dharnidharka, Vikas R.</creatorcontrib><creatorcontrib>Somers, Michael</creatorcontrib><creatorcontrib>Chua, Annabelle</creatorcontrib><creatorcontrib>Barcia, John</creatorcontrib><creatorcontrib>Hooper, David</creatorcontrib><creatorcontrib>Barletta, Gina‐Marie</creatorcontrib><creatorcontrib>Turman, Martin</creatorcontrib><creatorcontrib>Belsha, Craig</creatorcontrib><creatorcontrib>Harvey, Elizabeth</creatorcontrib><creatorcontrib>Salusky, Isidro</creatorcontrib><creatorcontrib>Yadin, Ora</creatorcontrib><creatorcontrib>Lee, Marsha</creatorcontrib><creatorcontrib>Langman, Craig</creatorcontrib><creatorcontrib>Atkinson, Meredith</creatorcontrib><creatorcontrib>Greenbaum, Laurence</creatorcontrib><creatorcontrib>Warady, Bradley</creatorcontrib><creatorcontrib>Bartosh, Sharon</creatorcontrib><creatorcontrib>Seikaly, Mouin</creatorcontrib><creatorcontrib>Zahr, Rima</creatorcontrib><creatorcontrib>Blydt‐Hansen, Tom</creatorcontrib><creatorcontrib>Lovell, Helen</creatorcontrib><creatorcontrib>Rheault, Michelle</creatorcontrib><creatorcontrib>Kumar, Juhi</creatorcontrib><creatorcontrib>Lee‐Son, Kathy</creatorcontrib><creatorcontrib>Benador, Nadine</creatorcontrib><creatorcontrib>Arar, Mazen</creatorcontrib><creatorcontrib>DeFreitas, Marissa</creatorcontrib><creatorcontrib>Luckritz, Kera</creatorcontrib><creatorcontrib>Fathallah‐Shaykh, Sahar</creatorcontrib><creatorcontrib>Flynn, Joseph</creatorcontrib><creatorcontrib>Raina, Rupesh</creatorcontrib><creatorcontrib>Pan, Cynthia</creatorcontrib><creatorcontrib>Patel, Hiren</creatorcontrib><creatorcontrib>Kapur, Gaurav</creatorcontrib><creatorcontrib>Czech, Kimberly</creatorcontrib><creatorcontrib>Cramer, Carl</creatorcontrib><creatorcontrib>Sharma, Amita</creatorcontrib><creatorcontrib>Lerner, Gary</creatorcontrib><creatorcontrib>Grushkin, Carl</creatorcontrib><creatorcontrib>Dharnidharka, Vikas</creatorcontrib><creatorcontrib>Chen, Ashton</creatorcontrib><creatorcontrib>Bock, Margret</creatorcontrib><creatorcontrib>Moudgil, Asha</creatorcontrib><creatorcontrib>Blaszak, Richard</creatorcontrib><creatorcontrib>Pal, Abhijeet</creatorcontrib><creatorcontrib>Nelson, Raoul</creatorcontrib><creatorcontrib>Richardson, Kelsey</creatorcontrib><creatorcontrib>Rio, Marcela Del</creatorcontrib><creatorcontrib>Sahney, Shoba</creatorcontrib><creatorcontrib>Sheth, Rita</creatorcontrib><creatorcontrib>Kees‐Folt, Deborah</creatorcontrib><creatorcontrib>Shah, Siddarth</creatorcontrib><creatorcontrib>Dell, Katherine</creatorcontrib><creatorcontrib>Srivaths, Poyyapakkam</creatorcontrib><creatorcontrib>Twichell, Sarah</creatorcontrib><creatorcontrib>Hunt, Elizabeth</creatorcontrib><creatorcontrib>Andreoli, Sharon</creatorcontrib><creatorcontrib>Gorman, Gregory</creatorcontrib><creatorcontrib>Puliyanda, Dechu</creatorcontrib><creatorcontrib>Laskin, Benjamin</creatorcontrib><creatorcontrib>Zaritsky, Joshua</creatorcontrib><creatorcontrib>Mathias, Robert</creatorcontrib><creatorcontrib>Wong, Cynthia</creatorcontrib><creatorcontrib>Massengill, Susan</creatorcontrib><creatorcontrib>Woroniecki, Robert</creatorcontrib><creatorcontrib>Pinsk, Maury</creatorcontrib><creatorcontrib>Brophy, Patrick</creatorcontrib><creatorcontrib>Aviles, Diego</creatorcontrib><creatorcontrib>Bell, Lorraine</creatorcontrib><creatorcontrib>Staples, Amy</creatorcontrib><creatorcontrib>Pillutla, Kartik</creatorcontrib><creatorcontrib>Lieberman, Kenneth</creatorcontrib><creatorcontrib>Feber, Janusz</creatorcontrib><creatorcontrib>Al‐Akash, Samhar</creatorcontrib><creatorcontrib>Ramirez, Jorge</creatorcontrib><creatorcontrib>Benfield, Mark</creatorcontrib><creatorcontrib>McKenney, Daniel</creatorcontrib><creatorcontrib>Constantinescu, Alexandru</creatorcontrib><creatorcontrib>Pena, Deogracias</creatorcontrib><creatorcontrib>Quiroga, Alejandro</creatorcontrib><creatorcontrib>Steinke, Julia</creatorcontrib><creatorcontrib>NAPRTCS investigators</creatorcontrib><creatorcontrib>the NAPRTCS 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>Barton, Kevin T.</au><au>Halani, Khalif</au><au>Galbiati, Shirley</au><au>Dandamudi, Raja</au><au>Hmiel, Stanley Paul</au><au>Dharnidharka, Vikas R.</au><au>Somers, Michael</au><au>Chua, Annabelle</au><au>Barcia, John</au><au>Hooper, David</au><au>Barletta, Gina‐Marie</au><au>Turman, Martin</au><au>Belsha, Craig</au><au>Harvey, Elizabeth</au><au>Salusky, Isidro</au><au>Yadin, Ora</au><au>Lee, Marsha</au><au>Langman, Craig</au><au>Atkinson, Meredith</au><au>Greenbaum, Laurence</au><au>Warady, Bradley</au><au>Bartosh, Sharon</au><au>Seikaly, Mouin</au><au>Zahr, Rima</au><au>Blydt‐Hansen, Tom</au><au>Lovell, Helen</au><au>Rheault, Michelle</au><au>Kumar, Juhi</au><au>Lee‐Son, Kathy</au><au>Benador, Nadine</au><au>Arar, Mazen</au><au>DeFreitas, Marissa</au><au>Luckritz, Kera</au><au>Fathallah‐Shaykh, Sahar</au><au>Flynn, Joseph</au><au>Raina, Rupesh</au><au>Pan, Cynthia</au><au>Patel, Hiren</au><au>Kapur, Gaurav</au><au>Czech, Kimberly</au><au>Cramer, Carl</au><au>Sharma, Amita</au><au>Lerner, Gary</au><au>Grushkin, Carl</au><au>Dharnidharka, Vikas</au><au>Chen, Ashton</au><au>Bock, Margret</au><au>Moudgil, Asha</au><au>Blaszak, Richard</au><au>Pal, Abhijeet</au><au>Nelson, Raoul</au><au>Richardson, Kelsey</au><au>Rio, Marcela Del</au><au>Sahney, Shoba</au><au>Sheth, Rita</au><au>Kees‐Folt, Deborah</au><au>Shah, Siddarth</au><au>Dell, Katherine</au><au>Srivaths, Poyyapakkam</au><au>Twichell, Sarah</au><au>Hunt, Elizabeth</au><au>Andreoli, Sharon</au><au>Gorman, Gregory</au><au>Puliyanda, Dechu</au><au>Laskin, Benjamin</au><au>Zaritsky, Joshua</au><au>Mathias, Robert</au><au>Wong, Cynthia</au><au>Massengill, Susan</au><au>Woroniecki, Robert</au><au>Pinsk, Maury</au><au>Brophy, Patrick</au><au>Aviles, Diego</au><au>Bell, Lorraine</au><au>Staples, Amy</au><au>Pillutla, Kartik</au><au>Lieberman, Kenneth</au><au>Feber, Janusz</au><au>Al‐Akash, Samhar</au><au>Ramirez, Jorge</au><au>Benfield, Mark</au><au>McKenney, Daniel</au><au>Constantinescu, Alexandru</au><au>Pena, Deogracias</au><au>Quiroga, Alejandro</au><au>Steinke, Julia</au><aucorp>NAPRTCS investigators</aucorp><aucorp>the NAPRTCS investigators</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Late first acute rejection in pediatric kidney transplantation: A North American Pediatric Renal Trials and Collaborative Studies special study</atitle><jtitle>Pediatric transplantation</jtitle><addtitle>Pediatr Transplant</addtitle><date>2021-08</date><risdate>2021</risdate><volume>25</volume><issue>5</issue><spage>e13953</spage><epage>n/a</epage><pages>e13953-n/a</pages><issn>1397-3142</issn><eissn>1399-3046</eissn><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.</abstract><cop>Denmark</cop><pub>Wiley Subscription Services, Inc</pub><pmid>33350558</pmid><doi>10.1111/petr.13953</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0001-8000-1385</orcidid><orcidid>https://orcid.org/0000-0001-8345-8604</orcidid></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1397-3142 |
| ispartof | Pediatric transplantation, 2021-08, Vol.25 (5), p.e13953-n/a |
| issn | 1397-3142 1399-3046 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2472111697 |
| source | MEDLINE; Wiley Online Library Journals Frontfile Complete |
| subjects | acute rejection Adolescent Child Child, Preschool Clinical trials Donor Selection - methods Donor Selection - trends Female Follow-Up Studies Graft rejection Graft Rejection - epidemiology Graft Rejection - etiology Humans Infant Infant, Newborn Kaplan-Meier Estimate Kidney Transplantation Kidney transplants Linear Models Male North America outcome pediatric Pediatrics Proportional Hazards Models Regression analysis renal transplant Retrospective Studies Risk Factors Time Factors Transplants & implants |
| title | Late first acute rejection in pediatric kidney transplantation: A North American Pediatric Renal Trials and Collaborative Studies special study |
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