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This study aimed to examine the long-term results of renal transplantation (RT) in children weighing less than 10 kilograms by comparing this group with children weighing more. The research was conducted using data from a single medical center and focused on children aged 18 or younger who had undergone RT.
The study's primary endpoints were 7-years graft survival and the estimated glomerular filtration rate (eGFR) at 1-, 3-, 5-, and 7-years post-transplant. The explanatory variable was the recipient's weight at the time of transplantation, categorizing subjects into two groups: Group 1 (weight ≤ 10 kg) and Group 2 (weight > 10 kg). Several confounding factors were considered, including the underlying cause of chronic kidney disease, donor type (living or deceased), recipient gender, donor age, recurrence of focal segmental glomerulosclerosis (FSGS), use of calcineurin inhibitors, graft dosage (expressed in grams per kilogram of recipient weight), and the duration of dialysis.
To explore the relationship between these variables and the study's outcomes, a multivariate Cox regression analysis was employed. The trajectories of eGFR were estimated using mixed-effects linear regression.
The study cohort consisted of 451 initial RT cases, with 53 in Group 1 and 398 in Group 2. The median age of the entire cohort was 7.6 years, with an interquartile range (IQR) ranging from 4.0 to 12.5 years. Sixty-four percent of the participants were male, and 53% had congenital anomalies of the kidney and urinary tract (CAKUT). Group 1 showed a higher percentage of living-related donors (28% compared to 17%) and a higher prevalence of CAKUT (64% compared to 52%) and hereditary diseases (23% compared to 13%), with results approaching statistical significance in both cases (p=0.06).
The 7-year graft survival rates were 86% in Group 1 and 84% in Group 2, with no statistically significant difference between the two groups (p=0.791). To account for the higher proportion of living donors in Group 1, additional analyses were conducted using only data from deceased donor cases, and these supplementary analyses did not alter the study's conclusions.
The mixed-effects model demonstrated that both groups had parallel declines in eGFR over time (p<0.001), with no significant difference between them (p=0.172).
The main finding of this study is the similarity in long-term RT outcomes between both groups. Consequently, these results provide support for renal transplantation in young children with low body weight.