Kidney transplantation for US children and adolescents with end-stage renal failure has continually improved year after year, with improved survival of both patients and the transplanted kidneys. But there’s still room for improvement, especially in certain groups, such as older adolescents.
The findings appear online today in Pediatrics.
Researchers assessed survival rates of all 17 446 US children and adolescents younger than 18 years who underwent kidney transplantation between 1987 and 2012. They found that 5-year survival rates for patients increased from 92.4% during 1987-1993 to 95.5% during 2005-2012. Average survival of the transplanted kidney increased from 65.9% during 1987-1993 to 78.6% during 2005-2012.
The researchers also found that the rate of transplanted kidneys, or grafts, that never functioned decreased from 15.4% in 1987 to 3.3% in 2011. The rate for delayed graft function decreased from 19.7% in 1987 to 5.3% in 2011. Delayed graft function is defined as the need for dialysis within the first 7 days after a kidney transplant and can sometimes last several weeks before it resolves.
The greatest progress in improving transplant outcomes occurred in the first year following transplantation. The risk of graft loss has decreased by 9% with each successive year of transplantation. The risk of graft loss after the first year following transplantation decreased by 2% with each successive year of transplantation. Lower rates of improvement in graft survival were seen in populations that already have lower graft survival in general: adolescents, female recipients, individuals who were undergoing dialysis before transplantation, and those diagnosed with a kidney disease called focal segmental glomerulosclerosis.
The author of an accompanying editorial noted rates of graft loss are especially increased in older adolescents and young adults. The editorialist suggested this may be because such individuals are less likely to take medications as prescribed, a situation that could be exacerbated by problems with access to health insurance for these populations. The editorialist also noted that scientists are researching novel approaches to improve the function and longevity of a transplanted kidney. Such approaches include measures that help patients acquire immune tolerance of the graft (reducing the likelihood that the patient’s immune system will work to reject the transplanted organ) and innovations for regenerating tissues and organs.