Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.
Children's Healthcare of Atlanta, Atlanta, GA, USA.
Pediatr Nephrol. 2019 Sep;34(9):1545-1555. doi: 10.1007/s00467-019-04264-0. Epub 2019 May 26.
Renal vascular thrombosis (RVT) is a major cause of early allograft loss in the first year following pediatric kidney transplantation. We examined recent trends in allograft loss due to RVT and identified associated risk factors.
We identified 14,640 kidney-only transplants performed between 1995 and 2014 with follow-up until June 30, 2016, in 13,758 pediatric patients aged < 19 years from the US Renal Data System. We examined the 1-year incidence of allograft loss due to RVT by year of transplant, and plotted the trend over time. Cox proportional hazards models were used to investigate the relationship between year of transplant as well as recipient, donor, and transplant characteristics with allograft loss due to RVT.
The incidence of allograft loss due to RVT consistently declined among pediatric kidney transplant performed between 1995 and 2014. Among transplants performed between 1995 and 2004, 128/7542 (1.7%) allografts were lost due to RVT compared to 53/7098 (0.8%) among transplants performed between 2005 and 2014; average 1-year cumulative incidence was 1.5% (95% CI, 1.3-1.9%) and 0.6% (95% CI, 0.5-0.8%), respectively. Increased risk for allograft loss due to RVT was associated with en bloc kidney transplantation (HR, 3.42; 95% CI 1.38-8.43) and cold ischemia time ≥ 12 h (HR, 1.78; 95% CI, 1.15-2.76). Interestingly, these risk factors were more prevalent in the latter decade.
The incidence of allograft loss due to RVT significantly and continuously declined among pediatric kidney transplants performed between 1995 and 2014. The causes for this improvement are unclear in the present analysis.
肾血管血栓形成（RVT）是儿童肾移植后第一年早期移植物丢失的主要原因。我们研究了近期因 RVT 导致移植物丢失的趋势，并确定了相关的危险因素。
我们在美国肾脏数据系统中确定了 1995 年至 2014 年间进行的 14640 例仅肾移植，随访至 2016 年 6 月 30 日，涉及 13758 名年龄<19 岁的儿科患者。我们按移植年份检查了因 RVT 导致的 1 年内移植物丢失的发生率，并绘制了随时间的变化趋势。Cox 比例风险模型用于研究移植年份以及受者、供者和移植特征与因 RVT 导致的移植物丢失之间的关系。
在 1995 年至 2014 年间进行的儿童肾移植中，因 RVT 导致的移植物丢失发生率持续下降。在 1995 年至 2004 年期间进行的移植中，有 128/7542（1.7%）的移植物因 RVT 丢失，而在 2005 年至 2014 年期间进行的移植中，有 53/7098（0.8%）的移植物丢失；平均 1 年累积发生率分别为 1.5%（95%CI，1.3-1.9%）和 0.6%（95%CI，0.5-0.8%）。因 RVT 导致的移植物丢失的风险增加与整块肾脏移植（HR，3.42；95%CI，1.38-8.43）和冷缺血时间≥12 小时（HR，1.78；95%CI，1.15-2.76）相关。有趣的是，这些危险因素在后者十年更为普遍。
在 1995 年至 2014 年间进行的儿童肾移植中，因 RVT 导致的移植物丢失的发生率显著且持续下降。在本分析中，这种改善的原因尚不清楚。
