Centre for Kidney Disease Research, University of Queensland, Brisbane, Queensland, Australia.
Department of Nephrology, Queensland Children's Hospital, Brisbane, Queensland, Australia.
Pediatr Transplant. 2022 Aug;26(5):e14224. doi: 10.1111/petr.14224. Epub 2022 Jan 10.
Data on sex-based disparities in children with kidney failure and outcomes after kidney transplantation are relatively sparse. This study examined the association between sex differences and the odds of receiving a pre-emptive living donor kidney transplantation, and post-transplant outcomes in children and adolescents.
We studied all patients (aged <20 years) who commenced kidney replacement therapy (KRT) between 2002 and 2017 using data from the ANZDATA Registry. Factors associated with graft loss and acute rejection after transplantation were assessed using multivariable Cox regression model. Differences in the odds of receiving a pre-emptive live donor transplant between sexes were assessed using adjusted logistic regression.
Of the 757 children transplanted during the study period, 497 (65.7%) received a live donor kidney (163, 21.5% pre-emptive). In total, 168 (22.2%) patients experienced graft loss and 213 (28.1%) patients experienced a first episode of acute rejection during the median follow-up period of 6.9 years (IQR 3.5-11.5 years). There were no differences in the rates of graft loss or acute rejection by sex. Compared with boys, the adjusted hazard ratios (aHR) (95% confidence interval) for graft loss and acute rejection in girls were 0.97 (0.71-1.33) and 1.09 (0.82-1.44), respectively. Among children who received living donor kidney transplants, there were no sex differences in the odds of receiving a pre-emptive transplant (adjusted odds ratio (aOR) 0.90 (95% CI 0.56-1.45)).
No sex differences were observed in the odds of receiving a pre-emptive living donor kidney transplant or outcomes after kidney transplantation.
关于儿童肾衰竭患者和肾移植后结局的性别差异的数据相对较少。本研究调查了性别差异与接受抢先活体供者肾移植的几率以及儿童和青少年肾移植后结局之间的关联。
我们使用 ANZDATA 登记处的数据研究了 2002 年至 2017 年间所有开始肾脏替代治疗（KRT）的患者（年龄<20 岁）。使用多变量 Cox 回归模型评估移植后移植物丢失和急性排斥反应的相关因素。使用调整后的逻辑回归评估性别之间接受抢先活体供者移植的几率差异。
在研究期间接受移植的 757 名儿童中，497 名（65.7%）接受了活体供者肾脏（163 名，21.5%为抢先）。在中位随访 6.9 年（IQR 3.5-11.5 年）期间，共有 168 名（22.2%）患者发生移植物丢失，213 名（28.1%）患者发生首次急性排斥反应。性别之间在移植物丢失或急性排斥反应的发生率方面无差异。与男孩相比，女孩的移植物丢失和急性排斥反应的调整危险比（aHR）（95%置信区间）分别为 0.97（0.71-1.33）和 1.09（0.82-1.44）。在接受活体供者肾移植的儿童中，接受抢先移植的几率在性别之间没有差异（调整优势比（aOR）0.90（95%CI 0.56-1.45））。
在接受抢先活体供者肾移植的几率或肾移植后的结局方面，未观察到性别差异。
