Risk factors for chronic rejection in pediatric renal transplant recipients - a single-center experience

Chronic rejection (CR) is the most common cause of graft loss beyond the Ist posttransplant year. The aim of this analysis was to identify the risk factors for the development of CR in pediatric renal transplant recipients. Between June 1984 and March 1994, 217 renal transplants were performed in children at our center. Immunosuppression included prednisone, azathioprine, cyclosporine (CsA), and prophylactic antibody. Using multivariate analysis, we studied the impact of the following variables on the development of biopsy-proven CR: age at transplant (less than or equal to 5 years, > 5 years), gender, race, transplant number (primary, retransplant), donor source (cadaver, living donor), donor age (<20 years, 20-49 years > 49 years), number of ABDR mismatches (0, 1-2, 3-4, 5-6), number of DR mismatches (0, 1, 2), percentage peak panel reactive antibody (PRA) (less than or equal to 50%, > 50%), percentage PRA at transplantation (less than or equal to 50%, > 50%), dialysis pretransplant, preservation time > 24 h, acute tubular necrosis requiring dialysis, initial CsA dosage (less than or equal to 5 mg/kg per day, > 5 mg/kg per day), CsA dosage at 1 year posttransplant (less than or equal to 5 mg/kg per day, > 5 mg/kg per day), acute rejection (AR), number of AR episodes (ARE) (1, > 1), timing of AR (less than or equal to 6 months, > 6 months), reversibility of AR (complete, partial), and infection [cytomegalovirus (CMV), non-CMV viral, bacterial]. Risk factors for the development of CR in pediatric renal transplant recipients were: AR (P <0.0001, odds ratio 19.4), multiple ARE(> 1 vs. I) (P <0.0001, odds ratio 30.1), and high percentage peak PRA (> 50%) (P <0.03, odds ratio 3.6).