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Repeat transplantation practices among pediatric kidney transplant recipients.

机译：在小儿肾脏移植接受者之间重复移植实践。

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摘要

Kidney transplantation is the preferred renal replacement therapy in children with end-stage renal disease, providing a significant survival advantage over dialysis (1, 2). Most pediatric kidney transplant recipients will eventually develop graft failure, but little is known about the utility of retransplantation in this population or the most advantageous retransplantation practices. To guide transplant practices and improve clinical decision-making among children with end-stage renal disease, we first examined retransplantation practice patterns and outcomes among pediatric kidney transplant recipients (Chapter 1). We found that racial and socioeconomic disparities exist with regard to retransplantation and that excellent graft survival can be achieved with retransplantation despite poor survival of previous grafts. Next, we quantified the changing risk of graft loss after pediatric kidney transplantation across post-transplant age (Chapter 2). We identified a dramatic increase in graft loss during late adolescence and early adulthood, a high-risk window that appears to affect all recipient subgroups and modify the relationship between typical recipient risk factors and graft loss. Next we compared retransplantation outcomes after pediatric kidney transplantation according to order of deceased donor and living donor transplantation (Chapter 3). We found that deceased donor kidney transplantation in pediatric recipients followed by living donor retransplantation does not negatively impact the living donor graft survival advantage and provides similar cumulative graft life compared to living donor kidney transplantation followed by deceased donor retransplantation. Finally, to address limitations of Chapter 3 (namely the difficulty of addressing sensitization risks, aging of the living donor, the high-risk age window, and deceased donor waiting times), we designed a Markov decision process model to compare the relative benefit of undergoing primary deceased donor vs. living donor kidney transplantation for a given pediatric patient with end-stage renal disease with one living donor available (Chapter 4). The results of these studies will be used by patients, nephrologists, and transplant providers to guide retransplantation practices and improve clinical decision-making for children who require kidney transplantation.
机译：肾移植是患有终末期肾脏疾病的儿童的首选肾脏替代疗法，与透析相比具有明显的生存优势（1、2）。大多数小儿肾脏移植受者最终都会发生移植失败，但对于该人群的再移植效用或最有利的再移植实践知之甚少。为了指导终末期肾病患儿的移植实践并改善其临床决策，我们首先研究了小儿肾脏移植接受者的再移植实践模式和结果（第1章）。我们发现在再移植方面存在种族和社会经济差异，尽管先前的移植物存活率较差，但通过再移植可以实现出色的移植物存活率。接下来，我们量化了整个移植后儿童肾脏移植后移植物丢失风险的变化（第2章）。我们发现青春期晚期和成年初期的移植物损失显着增加，这是一个高风险窗口，似乎影响了所有受体亚组，并改变了典型受体风险因素与移植物损失之间的关系。接下来，我们根据死者和活体供者的移植顺序比较了小儿肾脏移植后的再移植结果（第3章）。我们发现，与活体供体肾脏移植然后再去世的供体再移植相比，小儿受体供体死者肾脏移植后再进行活着的供者再移植不会对活体供体移植物的生存优势产生负面影响，并且提供了相似的累积移植寿命。最后，为解决第3章的局限性（即解决致敏风险的困难，活体供体的衰老，高风险年龄窗和已故的供体等待时间），我们设计了一个马尔可夫决策过程模型来比较对于一名患有终末期肾脏疾病的小儿患者，在有一位活体供体的情况下，接受原发性供体与活体供体肾移植的比较（第4章）。这些研究的结果将被患者，肾病学家和移植提供者用来指导重新移植的实践并改善需要肾脏移植的儿童的临床决策。

著录项

  • 作者

    Van Arendonk, Kyle J.;

  • 作者单位

    The Johns Hopkins University.;

  • 授予单位 The Johns Hopkins University.;
  • 学科 Health Sciences Surgery.
  • 学位 Ph.D.
  • 年度 2013
  • 页码 94 p.
  • 总页数 94
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类
  • 关键词

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