Loss of Pediatric Kidney Grafts During the “High–Risk Age Window”: Insights From Pediatric Liver and Simultaneous Liver–Kidney Recipients
Pediatric kidney transplant recipients experience a high–risk age window of increased graft loss during late adolescence and early adulthood that has been attributed primarily to sociobehavioral mechanisms such as nonadherence. An examination of how this age window affects recipients of other organs...
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| Veröffentlicht in: | American journal of transplantation 2015-02, Vol.15 (2), p.445-452 |
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| container_title | American journal of transplantation |
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| creator | Van Arendonk, K. J. King, E. A. Orandi, B. J. James, N. T. Smith, J. M. Colombani, P. M. Magee, J. C. Segev, D. L. |
| description | Pediatric kidney transplant recipients experience a high–risk age window of increased graft loss during late adolescence and early adulthood that has been attributed primarily to sociobehavioral mechanisms such as nonadherence. An examination of how this age window affects recipients of other organs may inform the extent to which sociobehavioral mechanisms are to blame or whether kidney‐specific biologic mechanisms may also exist. Graft loss risk across current recipient age was compared between pediatric kidney (n = 17,446), liver (n = 12,161) and simultaneous liver–kidney (n = 224) transplants using piecewise‐constant hazard rate models. Kidney graft loss during late adolescence and early adulthood (ages 17–24 years) was significantly greater than during ages |
| doi_str_mv | 10.1111/ajt.12985 |
| format | Article |
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This national registry study shows that the high‐risk age window associated with late adolescence and early adulthood, during which almost half of pediatric kidney transplants are lost, is significantly less detrimental to pediatric liver transplant survival.</description><identifier>ISSN: 1600-6135</identifier><identifier>EISSN: 1600-6143</identifier><identifier>DOI: 10.1111/ajt.12985</identifier><identifier>PMID: 25612497</identifier><language>eng</language><publisher>United States: Elsevier Limited</publisher><subject>Adolescent ; Age ; Age Factors ; Child ; Child development ; Child, Preschool ; Clinical research/practice ; Female ; Graft Rejection - epidemiology ; graft survival ; Humans ; Incidence ; Infant ; kidney (allograft) function/dysfunction ; Kidney Transplantation - statistics & numerical data ; kidney transplantation/nephrology ; Liver ; liver allograft function/dysfunction ; Liver Transplantation - statistics & numerical data ; liver transplantation/hepatology ; Male ; Outcome Assessment, Health Care ; Pediatrics ; Registries ; Retrospective Studies ; Risk Assessment ; Transplant Recipients ; Transplants & implants ; Young Adult</subject><ispartof>American journal of transplantation, 2015-02, Vol.15 (2), p.445-452</ispartof><rights>Copyright 2014 The American Society of Transplantation and the American Society of Transplant Surgeons</rights><rights>Copyright 2014 The American Society of Transplantation and the American Society of Transplant Surgeons.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c5095-97a35121376359ef07d9b01c38e60d3baa6d11515d1508d3557fe1627b1456503</citedby><cites>FETCH-LOGICAL-c5095-97a35121376359ef07d9b01c38e60d3baa6d11515d1508d3557fe1627b1456503</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fajt.12985$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fajt.12985$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>230,314,776,780,881,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25612497$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Van Arendonk, K. J.</creatorcontrib><creatorcontrib>King, E. A.</creatorcontrib><creatorcontrib>Orandi, B. J.</creatorcontrib><creatorcontrib>James, N. T.</creatorcontrib><creatorcontrib>Smith, J. M.</creatorcontrib><creatorcontrib>Colombani, P. M.</creatorcontrib><creatorcontrib>Magee, J. C.</creatorcontrib><creatorcontrib>Segev, D. L.</creatorcontrib><title>Loss of Pediatric Kidney Grafts During the “High–Risk Age Window”: Insights From Pediatric Liver and Simultaneous Liver–Kidney Recipients</title><title>American journal of transplantation</title><addtitle>Am J Transplant</addtitle><description>Pediatric kidney transplant recipients experience a high–risk age window of increased graft loss during late adolescence and early adulthood that has been attributed primarily to sociobehavioral mechanisms such as nonadherence. An examination of how this age window affects recipients of other organs may inform the extent to which sociobehavioral mechanisms are to blame or whether kidney‐specific biologic mechanisms may also exist. Graft loss risk across current recipient age was compared between pediatric kidney (n = 17,446), liver (n = 12,161) and simultaneous liver–kidney (n = 224) transplants using piecewise‐constant hazard rate models. Kidney graft loss during late adolescence and early adulthood (ages 17–24 years) was significantly greater than during ages <17 (aHR = 1.79, 95%CI = 1.69–1.90, p < 0.001) and ages >24 (aHR = 1.11, 95%CI = 1.03–1.20, p = 0.005). In contrast, liver graft loss during ages 17–24 was no different than during ages <17 (aHR = 1.03, 95%CI = 0.92–1.16, p = 0.6) or ages >24 (aHR = 1.18, 95%CI = 0.98–1.42, p = 0.1). In simultaneous liver–kidney recipients, a trend towards increased kidney compared to liver graft loss was observed during ages 17–24 years. Late adolescence and early adulthood are less detrimental to pediatric liver grafts compared to kidney grafts, suggesting that sociobehavioral mechanisms alone may be insufficient to create the high–risk age window and that additional biologic mechanisms may also be required.
This national registry study shows that the high‐risk age window associated with late adolescence and early adulthood, during which almost half of pediatric kidney transplants are lost, is significantly less detrimental to pediatric liver transplant survival.</description><subject>Adolescent</subject><subject>Age</subject><subject>Age Factors</subject><subject>Child</subject><subject>Child development</subject><subject>Child, Preschool</subject><subject>Clinical research/practice</subject><subject>Female</subject><subject>Graft Rejection - epidemiology</subject><subject>graft survival</subject><subject>Humans</subject><subject>Incidence</subject><subject>Infant</subject><subject>kidney (allograft) function/dysfunction</subject><subject>Kidney Transplantation - statistics & numerical data</subject><subject>kidney transplantation/nephrology</subject><subject>Liver</subject><subject>liver allograft function/dysfunction</subject><subject>Liver Transplantation - statistics & numerical data</subject><subject>liver transplantation/hepatology</subject><subject>Male</subject><subject>Outcome Assessment, Health Care</subject><subject>Pediatrics</subject><subject>Registries</subject><subject>Retrospective Studies</subject><subject>Risk Assessment</subject><subject>Transplant Recipients</subject><subject>Transplants & implants</subject><subject>Young Adult</subject><issn>1600-6135</issn><issn>1600-6143</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kc1uEzEUhS0EoqWw4AWQJTawSOtrjz0zLCpFhf5AJFApYmk5Y0_iMGMHe6ZVdnkFxBZeLk-Cy4SoIHE3tnw_n3OvDkJPgRxCqiO16A6BlgW_h_ZBEDISkLH7uzvje-hRjAtCIKcFfYj2KBdAszLfR98mPkbsa_zBaKu6YCv8zmpnVvgsqLqL-HUfrJvhbm7wZv3j3M7mm_X3Sxu_4PHM4M_WaX-zWf98hS9cTM304zT49o7cxF6bgJXT-KNt-6ZTzvg-Ds9Jaut2aSq7tMZ18TF6UKsmmifb8wB9On1zdXI-mrw_uzgZT0YVJyUflbliHCiwXDBemprkupwSqFhhBNFsqpTQABy4Bk4KzTjPawOC5lPIuOCEHaDjQXfZT1ujq-QdVCOXwbYqrKRXVv7dcXYuZ_5aZozmqZLAi61A8F97EzvZ2liZphk2lCA4zQgncOv1_B904fvg0nqJyvKMUCKKRL0cqCqkUIKpd8MAkbdByxS0_B10Yp_dnX5H_kk2AUcDcGMbs_q_khy_vRokfwFu3rZP</recordid><startdate>201502</startdate><enddate>201502</enddate><creator>Van Arendonk, K. J.</creator><creator>King, E. A.</creator><creator>Orandi, B. J.</creator><creator>James, N. T.</creator><creator>Smith, J. M.</creator><creator>Colombani, P. M.</creator><creator>Magee, J. C.</creator><creator>Segev, D. L.</creator><general>Elsevier Limited</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>7QP</scope><scope>7T5</scope><scope>7U9</scope><scope>H94</scope><scope>K9.</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>201502</creationdate><title>Loss of Pediatric Kidney Grafts During the “High–Risk Age Window”: Insights From Pediatric Liver and Simultaneous Liver–Kidney Recipients</title><author>Van Arendonk, K. J. ; King, E. A. ; Orandi, B. J. ; James, N. T. ; Smith, J. M. ; Colombani, P. M. ; Magee, J. C. ; Segev, D. 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J.</creatorcontrib><creatorcontrib>King, E. A.</creatorcontrib><creatorcontrib>Orandi, B. J.</creatorcontrib><creatorcontrib>James, N. T.</creatorcontrib><creatorcontrib>Smith, J. M.</creatorcontrib><creatorcontrib>Colombani, P. M.</creatorcontrib><creatorcontrib>Magee, J. C.</creatorcontrib><creatorcontrib>Segev, D. L.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Immunology Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>American journal of transplantation</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Van Arendonk, K. J.</au><au>King, E. A.</au><au>Orandi, B. J.</au><au>James, N. T.</au><au>Smith, J. M.</au><au>Colombani, P. M.</au><au>Magee, J. C.</au><au>Segev, D. L.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Loss of Pediatric Kidney Grafts During the “High–Risk Age Window”: Insights From Pediatric Liver and Simultaneous Liver–Kidney Recipients</atitle><jtitle>American journal of transplantation</jtitle><addtitle>Am J Transplant</addtitle><date>2015-02</date><risdate>2015</risdate><volume>15</volume><issue>2</issue><spage>445</spage><epage>452</epage><pages>445-452</pages><issn>1600-6135</issn><eissn>1600-6143</eissn><abstract>Pediatric kidney transplant recipients experience a high–risk age window of increased graft loss during late adolescence and early adulthood that has been attributed primarily to sociobehavioral mechanisms such as nonadherence. An examination of how this age window affects recipients of other organs may inform the extent to which sociobehavioral mechanisms are to blame or whether kidney‐specific biologic mechanisms may also exist. Graft loss risk across current recipient age was compared between pediatric kidney (n = 17,446), liver (n = 12,161) and simultaneous liver–kidney (n = 224) transplants using piecewise‐constant hazard rate models. Kidney graft loss during late adolescence and early adulthood (ages 17–24 years) was significantly greater than during ages <17 (aHR = 1.79, 95%CI = 1.69–1.90, p < 0.001) and ages >24 (aHR = 1.11, 95%CI = 1.03–1.20, p = 0.005). In contrast, liver graft loss during ages 17–24 was no different than during ages <17 (aHR = 1.03, 95%CI = 0.92–1.16, p = 0.6) or ages >24 (aHR = 1.18, 95%CI = 0.98–1.42, p = 0.1). In simultaneous liver–kidney recipients, a trend towards increased kidney compared to liver graft loss was observed during ages 17–24 years. Late adolescence and early adulthood are less detrimental to pediatric liver grafts compared to kidney grafts, suggesting that sociobehavioral mechanisms alone may be insufficient to create the high–risk age window and that additional biologic mechanisms may also be required.
This national registry study shows that the high‐risk age window associated with late adolescence and early adulthood, during which almost half of pediatric kidney transplants are lost, is significantly less detrimental to pediatric liver transplant survival.</abstract><cop>United States</cop><pub>Elsevier Limited</pub><pmid>25612497</pmid><doi>10.1111/ajt.12985</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adolescent Age Age Factors Child Child development Child, Preschool Clinical research/practice Female Graft Rejection - epidemiology graft survival Humans Incidence Infant kidney (allograft) function/dysfunction Kidney Transplantation - statistics & numerical data kidney transplantation/nephrology Liver liver allograft function/dysfunction Liver Transplantation - statistics & numerical data liver transplantation/hepatology Male Outcome Assessment, Health Care Pediatrics Registries Retrospective Studies Risk Assessment Transplant Recipients Transplants & implants Young Adult |
| title | Loss of Pediatric Kidney Grafts During the “High–Risk Age Window”: Insights From Pediatric Liver and Simultaneous Liver–Kidney Recipients |
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