R LALJI1,2,3, A FRANCIS1,2,3, D JOHNSON2,3,7, G WONG4,5,6
1Queensland Children’s Hospital, South Brisbane, Australia, 2Centre for Kidney Disease Research, University of Queensland, St Lucia, Australia, 3Metro South and Integrated Nephrology and Transplant Service (MINT), Princess Alexandra Hospital, Woolloongabba, Australia, 4Sydney School of Public Health, University of Sydney, Sydney, Australia, 5Centre for Kidney Research, The Children’s Hospital at Westmead, Westmead, Australia, 6Centre for Transplant and Renal Research, Westmead Institute for Medical Research, University of Sydney, Sydney, Australia, 7Translational Research Institute, Brisbane, Australia
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 pediatric 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.
Dr Rowena Lalji is paediatric nephrologist and PhD candidate at the Centre for Kidney Research based in Brisbane, Australia. She completed her basic paediatric and early nephrology career in Brisbane before moving to London in 2016 to complete her specialist training at Great Ormond Street Hospital for Children. Rowena was admitted as a Fellow of the RACP in Paediatric Nephrology in 2018 and spent six months working at Starship Children’s Hospital in NZ before returning home to work at Queensland Children’s Hospital in early 2019. Her PhD focuses on the impact of social disparity on access to care and overall health outcomes of children with chronic kidney disease. Rowena is an International Society of Nephrology (ISN) Fellow (2018-2020), the first paediatric specific ambassador to be awarded this honour.