Abstract：
BACKGROUND: Approximately 2500 pediatric patients are awaiting kidney transplantation in the United States, with <5% comprising those ≤15 kg. Transplant in this cohort is often delayed by center-based growth parameters, often necessitating transplantation after the initiation of dialysis. Furthermore, prognostication remains somewhat ambiguous. In this report, we scrutinize the Organ Procurement and Transplantation Network (OPTN) data from 2001 to 2021 to help better understand specific variables impacting graft and patient outcomes in these children.
METHODS: The OPTN kidney transplant dataset from 2001 to 2021 was analyzed. Inclusion criteria included age <18 years, weight ≤15 kg, and recipient of primary living donor kidney transplantation (LDKT) or deceased donor kidney transplantation (DDKT). Patient and graft survival probabilities were calculated using the Kaplan-Meier method. The Cox proportional hazards model was used to calculate hazard ratio (HR) and identify variables significantly associated with patient and graft survival.
RESULTS: Two thousand one hundred sixty-eight pediatric transplant recipients met inclusion criteria. Patient survival at 1 and 3 years was 98% and 97%, respectively. Graft survival at 1 and 3 years was 95% and 92%, respectively. Dialysis was the sole significant variable impacting both patient and graft survival. Graft survival was further impacted by transplant era, recipient gender and ethnicity, and donor type. Infants transplanted at Age 1 had better graft survival compared with older children, and nephrotic syndrome was likewise associated with a better prognosis.
CONCLUSIONS: Pediatric kidney transplantation is highly successful. The balance between preemptive transplantation, medical optimization, and satisfactory technical parameters seems to suggest a \"Goldilocks zone\" for many children, favoring transplantation between 1 and 2 years of age.
METHODS: The OPTN kidney transplant dataset from 2001 to 2021 was analyzed. Inclusion criteria included age <18 years, weight ≤15 kg, and recipient of primary living donor kidney transplantation (LDKT) or deceased donor kidney transplantation (DDKT). Patient and graft survival probabilities were calculated using the Kaplan-Meier method. The Cox proportional hazards model was used to calculate hazard ratio (HR) and identify variables significantly associated with patient and graft survival.
RESULTS: Two thousand one hundred sixty-eight pediatric transplant recipients met inclusion criteria. Patient survival at 1 and 3 years was 98% and 97%, respectively. Graft survival at 1 and 3 years was 95% and 92%, respectively. Dialysis was the sole significant variable impacting both patient and graft survival. Graft survival was further impacted by transplant era, recipient gender and ethnicity, and donor type. Infants transplanted at Age 1 had better graft survival compared with older children, and nephrotic syndrome was likewise associated with a better prognosis.
CONCLUSIONS: Pediatric kidney transplantation is highly successful. The balance between preemptive transplantation, medical optimization, and satisfactory technical parameters seems to suggest a \"Goldilocks zone\" for many children, favoring transplantation between 1 and 2 years of age.
摘要：
背景：在美国，大约2500名儿科患者正在等待肾移植，<5%，包括≤15公斤。该队列中的移植通常因基于中心的生长参数而延迟，通常需要在透析开始后进行移植。此外，预测仍然有些模棱两可。在这份报告中,我们仔细检查了2001年至2021年的器官采购和移植网络(OPTN)数据,以帮助更好地了解影响这些儿童移植和患者结局的特定变量.
方法：分析了2001年至2021年的OPTN肾移植数据集。纳入标准包括年龄<18岁，重量≤15公斤，和主要活体肾移植（LDKT）或死亡供体肾移植（DDKT）的接受者。使用Kaplan-Meier方法计算患者和移植物存活概率。Cox比例风险模型用于计算风险比（HR）并识别与患者和移植物存活显着相关的变量。
结果：两千六十八名儿科移植受者符合纳入标准。患者1年和3年生存率分别为98%和97%，分别。1年和3年的移植物存活率分别为95%和92%，分别。透析是影响患者和移植物存活的唯一重要变量。移植物存活进一步受到移植时代的影响，接受者的性别和种族，和捐赠者类型。与年龄较大的儿童相比，1岁时移植的婴儿有更好的移植物存活率，肾病综合征也与较好的预后相关.
结论：小儿肾移植非常成功。抢先移植之间的平衡，医疗优化,令人满意的技术参数似乎暗示了许多孩子的“金发姑娘区”，有利于1至2岁之间的移植。
方法：分析了2001年至2021年的OPTN肾移植数据集。纳入标准包括年龄<18岁，重量≤15公斤，和主要活体肾移植（LDKT）或死亡供体肾移植（DDKT）的接受者。使用Kaplan-Meier方法计算患者和移植物存活概率。Cox比例风险模型用于计算风险比（HR）并识别与患者和移植物存活显着相关的变量。
结果：两千六十八名儿科移植受者符合纳入标准。患者1年和3年生存率分别为98%和97%，分别。1年和3年的移植物存活率分别为95%和92%，分别。透析是影响患者和移植物存活的唯一重要变量。移植物存活进一步受到移植时代的影响，接受者的性别和种族，和捐赠者类型。与年龄较大的儿童相比，1岁时移植的婴儿有更好的移植物存活率，肾病综合征也与较好的预后相关.
结论：小儿肾移植非常成功。抢先移植之间的平衡，医疗优化,令人满意的技术参数似乎暗示了许多孩子的“金发姑娘区”，有利于1至2岁之间的移植。
