Factors affecting prognosis in children undergoing kidney transplatation

Objective: Kidney transplantation is the most effective renal replacement therapy in children, improving both survival and quality of life. This study aimed to identify clinical, immunological, and demographic factors influencing graft and patient outcomes in pediatric kidney transplant recipients followed at our center. Materials and Methods: Clinical, laboratory, and follow-up data from 66 pediatric kidney transplant recipients monitored between 2009 and 2022 were evaluated to determine factors associated with graft loss. Results: Of the patients, 56.1% were male and 43.9% were female, with a transplant age range of 1.23–17.9 years (mean 11.6 ± 4). The preemptive transplant rate was 31.8%, and congenital urological anomalies were the most common etiology. Complete HLA matching was observed in only 4.7% of recipients. Early postoperative complications occurred in 40% and delayed graft function in 10% of patients. Acute rejection suspicion was noted in 68.2%, with acute T-cell–mediated rejection being the most frequent type (27.3%). Non-rejection findings included calcineurin inhibitor toxicity, chronic allograft nephropathy, and occasional polyomavirus nephropathy. Rejection rates did not differ across age groups, and pre-transplant variables—including HLA mismatch—were not associated with biopsy-proven rejection (p>0.05). Graft loss was significantly higher in patients experiencing rejection within the first 6–12 months (p<0.05). Calcineurin inhibitor toxicity and chronic allograft nephropathy were also linked to increased graft loss (p=0.022 and p<0.001). Overall, 22.7% experienced graft loss, most commonly due to chronic allograft injury (40%), rejection (20%), surgical complications (13.3%), and disease recurrence (6.7%). Patient survival exceeded 98% during the first 5 years, while graft survival was 93.9%, 88.9%, and 80.8% at 1, 3, and 5 years, respectively, and 51.5% at 10 years. Conclusion: Early rejection, glomerular disease etiology, low first-year GFR, and non-adherence to immunosuppressive therapy were identified as the main determinants of graft loss in pediatric kidney transplantation. Early recognition and management of these risks may improve graft survival. Keywords: kidney transplantation, pediatric patients, graft survival