Factors associated with allograft loss in Australian and new zealand paediatric kidney transplant patients

Abstract

Aim: To define the factors associated with longer-term allograft loss in Australian and New Zealand paediatric kidney transplant recipients. Background: Disparities in transplant outcomes exist in paediatric kidney transplant recipients, and may include a complex interplay of epidemiological, immunological and socioeconomic factors. Methods: Using data from the Australian and New Zealand Dialysis and Transplant Registry (2002-2017), we explored the factors associated with allograft loss using multivariable Cox regression modelling, accounting for the competing event of death. Results: Of the 757 patients included in the analysis (59.0% male, 76.5% European Australians), live donors accounted for 65.7% of all transplants (59.8% male), 22.2% of those being preemptive (66.1% male). The cumulative incidences of allograft loss at five and ten years were 1.7% (95%CI 1.0-2.9%) and 2.1% (95%CI 1.3-3.4%), respectively over median follow-up of 6.9 years (IQR 3.5-11.5) and a total follow-up of 5576 person years. Overall, 168 patients experienced allograft loss during the follow-up period (54.8% male) with 12 patient deaths (75% male). Factors associated with allograft loss included Aboriginal and Torres Strait Islander heritage [aHR (95%CI) 1.9 (1.1-3.4) vs Caucasian ethnicity], adolescent age [1.7 (1-2.8) vs young children], receipt of a deceased donor kidney [1.3 (1.1-1.6)] and earlier transplant era (2002-2009) [1.6 (1-2.5)], adjusted for patient sex and primary kidney disease. There were no significant interactions between sex and ethnicity (p = 0.8). Conclusions: Aboriginal and Torres Strait Islander ethnicity, deceased donor transplantation, adolescence and earlier transplant era were independently associated with allograft loss.L6339279072021-01-20 <br />