ESPN 51th Annual Meeting

ESPN 2018


 
Declining rates of renal allograft loss due to thrombosis in children despite increased risk factors for thrombosis
CHIA-SHI WANG 2 LARRY GREENBAUM 2 ROUBA GARRO 2 BARRY WARSHAW 1 ROSHAN GEORGE 2 PAMELA WINTERBERG 2 KAVITA PATEL 3 RACHEL PATZER 4 JULIEN HOGAN 1

1- PEDIATRIC NEPHROLOGY DEPARTMENT ROBERT DEBRE HOSPITAL, APHP, PARIS, FRANCE
2- DEPARTMENT OF PEDIATRICS, EMORY UNIVERSITY SCHOOL OF MEDICINE, ATLANTA, GA, USA
3- AFLAC CANCER AND BLOOD DISORDERS, CHILDREN’S HEALTHCARE OF ATLANTA, ATLANTA, GA, USA
4- DEPARTMENT OF SURGERY, EMORY UNIVERSITY SCHOOL OF MEDICINE, ATLANTA, GA, USA
 
Introduction:

 Renal vascular thrombosis (RVT) is a major cause of early allograft loss in pediatric recipients. Several risk factors of RVT have been reported. However, the assessement of independant risk factors of RVT is hampered by limited sample sized and the scarcity of early graft loss. Thus, we examined trends in allograft loss due to RVT in the USA and studied risk factors associated with RVT. 

Material and methods:

We included 17,078 renal transplantations performed in 15,991 pediatric patients age <19 years between 1995-2015 registered in USRDS. Crude incidence of allograft loss due to thrombosis was examined using cumulative incidence function to account for the competing risk of death and allograft loss due to other causes. Cox Proportional Hazards models were used to investigate the association between risk factors and RVT.

Results:

Between 1995-2005, 139/8661 (1.6%) allografts were lost due to RVT, with a 1-year cumulative incidence of 1.3% ( 95% CI [1.1-1.6%]). In 2006-2015, this decreased to 56/8,417 (0.67%) allografts and a 1-year cumulative incidence of 0.4% ( 95% CI [0.3-0.6%]). Transplantation in the latter decade was associated with decreased risk for allograft loss due to RVT (hazard ratio [95% CI] 0.44 [0.32-0.61]). In the same model, donor-recipient weight ratio >5 (1.70 [1.05-2.77]), use of en bloc kidneys (2.94 [1.22-7.10]), and increased cold ischemia time (1.02 [1.01-1.04]) were significantly associated with increased risk for allograft loss due to RVT.

Conclusions:

1-year incidence of allograft loss due to RVT in pediatric renal transplantation has decreased despite performing transplantations at higher risk for thrombosis in recent years. Further studies are needed to explore unexamined factors that may contribute to the reduced risk of allograft loss due to RVT and successful strategies for RVT prevention and treatment.