Comparison of Renal Transplantation Outcomes in Pediatric Patients with Urologic and Non-Urologic ESRD
Joshua Weinberg, MD, Adriana Crespo, MS, Brian Wiseman, MD, Wei Xue, PhD, Bayne Christopher, MD, Romano DeMarco, MD.
University of Florida, Gainesville, FL, USA.
BACKGROUND: In 2016, the U.S. incidence of ESRD in pediatric patients was 15.9 per 1 million people, with 20-30% of those cases caused by a urological condition. Previous reports have shown that children with non-urologic causes of ESRD had better transplant results than those with a urologic condition. We reviewed our pediatric renal transplant experience to determine if there was a difference in transplant outcomes between urologic and those with non-urologic ESRD.
METHODS: We performed a review of all pediatric patients who have received a renal transplant between 1/1990-4/2016. Data recorded included cause of ESRD, age at transplant, type of transplant, clinical condition at last follow up, assessment of bladder dynamics, management of patients with abnormal lower urinary tracts, renal function, patient outcomes following transplant, and cause of graft loss. Patients were categorized as having a “urologic” cause of ESRD if they had lower urinary tract dysfunction (LUTD) or “non-urologic” to define all other causes of ESRD. Statistical analysis including Kaplan Meier survival curves were performed, controlling for age, sex and type of donor (living vs deceased).
RESULTS: A total of 208 children had renal transplantation, 49 for urologic causes and 159 for non-urologic causes. Mean age at transplant was 11.3 years old (range from 16 months to 215 months) with 9.8 year mean length of follow-up. 125 children were males (60.1%) and 83 were females (39.9%), with 142 having received a deceased donor kidney and 66 a living directed donor transplant. The most common cause of urologic ESRD was PUV (65%) with the most common etiology in the non-urologic group being non-specified renal dysplasia (32.1%). After adjusting for covariates, the difference in transplant viability time between urological and non-urological groups was borderline significant (p-value = 0.08), with urologic children having increased transplant survival times compared to non-urologic.
CONCLUSIONS: Children with urologic causes of ESRD had better transplant survival times than children with non-urologic causes in our review. These findings could be related to the modifiable factors that can be addressed in children with urologic conditions.
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