Outcomes Improving for Pediatric Kidney Transplant Recipients

If a child needed a kidney transplant 40 years ago, their chance of one-year survival was 85 percent.

But a new study in the Journal of the American College of Surgeons led by Srinath Chinnakotla, M.D., FACS, associate professor within the Department of Surgery at University of Minnesota Medical School, found pediatric kidney transplant patients have a near 100 percent chance of one-year survival today.

“The outlook for infants and children with end-stage kidney disease was once dismal, with poor survival rates after transplant,” said Chinnakotla. “But many advancements, like better surgical techniques, antirejection medications and living donor protocols, have significantly improved outcomes.”

Using medical records from University of Minnesota Masonic Children’s Hospital, Chinnakotla and colleagues analyzed 1,056 pediatric kidney transplants performed between June 1963 and October 2016. Researchers categorized the data into three eras and evaluated patient survival rates and other outcomes. Era 1 was from 1963 through 1983; Era 2 was from 1984 to 2001; and Era 3 was from 2002 to 2016.

In addition to the improved one-year survival, data showed significant improvement in kidney function after 10 years, which is known as “graft survival.” Just 42 percent of patients in Era 1 had graft survival at 10 years. By Era 3, 70 percent of patients had graft survival at 10 years.

“Thanks to advances in immunosuppressive [antirejection] medications including steroid-free drugs, better surgical technique, and improved management of infections after kidney transplant, children ages 10 years and younger now have the best long-term graft survival of all ages,” said Chinnakotla.

Living donor kidney transplants – a procedure pioneered at the University of Minnesota – were also found to have a major impact on survival and kidney function.

During Era 3, 10-year graft survival rate was 78 percent for living donor transplants compared to 57 percent for deceased donor transplants. Additionally, half of all living-donor transplants in Era 3 are projected to still be functioning at 25 years, six years longer than deceased donor grafts. Even when the donor was not related to the transplant recipient, living-donor graft survival was superior.

“For children with end-stage kidney disease,” Dr. Chinnakotla said. “Kidney transplant is the only therapy that offers them the long-term possibility of a near-normal life, and a living-donor graft is their best option.”