East Carolina University, E 5thSt, Greenville, NC, 27858, USA.
Department of Pediatrics, Brody School of Medicine at East, Carolina University, Greenville, NC, USA.
Pediatr Nephrol. 2024 Nov;39(11):3309-3316. doi: 10.1007/s00467-024-06445-y. Epub 2024 Jul 4.
Pediatric patients with kidney failure often experience cognitive delays. However, academic delay (being more than one grade level below age-appropriate grade, or in special education) after pediatric kidney transplantation (KTx) has not been explored. We sought to identify patient characteristics associated with a higher risk of academic delay 1 year post-KTx.
We used the United Network for Organ Sharing (UNOS) database to identify children aged 6-17 years who received a primary KTx between 2014 and 2021 and had a functioning graft 1 year after KTx. The primary outcome was the patient's academic progress at 1 year post-transplant. The secondary outcome was change in academic progress between transplant and 1-year follow-up: onset of new delay, resolution of pre-existing delay, persistence of delay, or no delay at either timepoint. Binomial and multinomial mixed effects logistic regression models were used to predict each outcome based on patient characteristics.
The study included 2197 patients, of whom 14% demonstrated academic delay at 1 year post-KTx, 4% demonstrated a new onset of academic delay, 5% demonstrated a resolution of academic delay, and 10% demonstrated persistent academic delay. Patients undergoing transplantation at a younger age, receiving a deceased donor kidney, experiencing longer waitlist times, and undergoing KTx for vascular or other disease indications for KTx were more likely to experience academic delays, including new-onset academic delays.
Academic delays are frequently reported among pediatric KTx recipients. Additional academic support may help resolving or preventing academic delay for at-risk subgroups of children undergoing KTx.
患有肾衰竭的儿科患者常出现认知延迟。然而，儿科肾移植（KTx）后出现学业延迟（落后于年龄相应年级一级或以上，或接受特殊教育）尚未得到研究。我们试图确定与 KTx 后 1 年发生更高学业延迟风险相关的患者特征。
我们使用美国器官共享网络（UNOS）数据库，确定 2014 年至 2021 年间接受初次 KTx 的 6-17 岁儿童，并在 KTx 后 1 年获得功能移植物。主要结局是患者在移植后 1 年内的学业进展。次要结局是移植和 1 年随访之间学业进展的变化：新出现的延迟、先前存在的延迟的解决、持续存在的延迟或在任何时间点均无延迟。二项式和多项式混合效应逻辑回归模型用于根据患者特征预测每个结局。
该研究纳入了 2197 名患者，其中 14%的患者在 KTx 后 1 年出现学业延迟，4%的患者出现新的学业延迟，5%的患者出现学业延迟的解决，10%的患者出现持续的学业延迟。接受移植时年龄较小、接受已故供者肾、等待时间较长以及因血管或其他疾病接受 KTx 的患者更可能出现学业延迟，包括新出现的学业延迟。
儿科 KTx 受者常出现学业延迟。对于接受 KTx 的高危亚组儿童，额外的学业支持可能有助于解决或预防学业延迟。
