Excellent Long-Term Outcomes With Infant Kidney Transplants

The outcomes for children with kidney disease who receive transplants as infants were improved, according to a new UC Davis study. The study was published in the journal Transplantation Direct.

Infant kidney transplants comprise a small percentage of all pediatric kidney transplants in the U.S. Since January 1, 2000, the Organ Procurement and Transplantation Network (OPTN) database reports that fewer than half of 1% of all kidney transplants were infants.

‘An infant kidney transplant has a higher graft failure rate in the first year compared to preteen and teen kidney transplants but the failure rates are comparable or even lower after the first year.’

Care providers often wait until an infant grows larger because of the technical challenges of performing this surgery on a small recipient. Most prefer to put infants on dialysis in the hopes of improving patient survival odds and limiting graft failure, which is when the body rejects the transplanted organ.

To compare the success between infant kidney transplant and teen kidney transplant, a new study reviewed 2,696 pediatric kidney transplant patients who had their first kidney transplant between Jan. 1, 2000, and Dec. 31, 2015.

Of these patients, 27 were infant recipients. The study excluded recipients who had a graft failure on the day of their transplant.

The study measured outcomes overtime for three pediatric age categories, based on their age at the time of transplant: infants (1 year and younger), preteens (ages 1 to 11), and teenagers (ages 12 to 17).

The study found that the number of infant kidney transplants remained steady, ranging from zero in many years to a peak of five in 2006. There was no trend in the number of infant kidney transplants over time.

The infant recipients were more likely to be male, have structural causes of chronic kidney failure, and have hypoalbuminemia, a low level of albumin protein in the blood.

The majority of infant and pediatric kidney recipients had experienced a period of dialysis before their transplant. The highest graft failure rates were seen in the first year after transplant: 10.4% of infants compared with 3.8% of both preteens and teens.

But these failure rates progressively declined over time. Five years after transplant, 16.4% of infants, 13.6% of preteens, and 19.9% of teens experienced graft failures.

The study emphasizes that all kidney transplants should be performed in experienced centers, like UC Davis Children's Hospital, to minimize risk.

The study noted the data from the OPTN database revealed that kidney transplants were concentrated in a few geographic areas, reflecting the comfort level and expertise of just a few transplant teams to perform kidney transplants on infants.

This study serves as an optimistic reminder for transplant centers with the technical expertise and experience in caring for this high-risk population not to delay performing transplants solely based on recipient size and age.

Source: Medindia