Progression of Chronic Kidney Disease in Pediatric Patient With Kidney Transplantation

Introduction: The Glomerular Filtration Rate (GFR) at 1st year post transplantation is reported as a good predictor of long-term renal allograft survival after a primary kidney transplant. Objectives: To evaluate the stage of CKD according to GFR in the first five years after transplantation in patients who received their first kidney transplant. To estimate GFR at the 1st and 5th year post transplantation and to compare them between living related donor (LRD) and deceased donor (DD) kidney transplant recipients. Methodology: We retrospectively analyzed GFR in all pediatric primary kidney transplant recipients from January 2000 to December 2020 in our Pediatric Kidney transplant Unit at 1st and 5th year post transplantation. GFR was assessed by use of the bedside Schwartz formula. Results: 133 pediatric c kidney transplant recipients (mean age 10.9 ± 6 yr; mean follow-up 10.23 ± 3.8 yr) were enrolled. 62% were men, in 77 (57.8%) the cause of ESkD was CAKUT; 94 (70.6%) received a LRD graft and 26 (19.5%) received a preemptive transplant. GFR and stage of CKD in the first five years after transplantation are shown in Table 1. The average drop in GFR during the first 5 years after transplant was 2.96 ml/min per year. Kaplan–Meier analysis (Figure 1) disclosed that long-term graft survival was significantly better after a LRD than DD kidney transplant (p<0.0001). But those DD kidney recipients that don’t develop graft loss had significantly higher GRF after the fifth year post transplant than LRD recipients (78.4+/-34.7 vs 61.4+/-19.4) (p<0.005). GFR was significantly decreased in those children who received a kidney graft when they were >10 years old at 5 th year (74.7+/-23.3 vs 58.1+/-26.2)(p<0.0004) after transplantation and there was no statistically significant difference in GFR in terms of the underlying CKD disease or preemptive transplantation. Conclusion: Graft survival was significantly better after a living related donor (LRD) than deceased donor (DD) kidney transplant, but in terms of GFR, those DD kidney recipients that don’t develop graft loss had significantly higher GRF after fifth year post transplant than LRD recipients.