Younger Age and Antibody Induction Increase the Risk for Infection in Pediatric Renal Transplantation: A NAPRTCS Report
03/2007
Journal Article
Authors:
Puliyanda, D.;
Stablein, D.;
Dharnidharka, V.
Secondary:
Am J Transplant
Volume:
7
Pagination:
662-666
URL:
http://www.ncbi.nlm.nih.gov/pubmed/17250558
Keywords:
Antibodies; Bacterial Infections; Child; Female; Hospitalization; Immunosuppression; Infant; kidney transplantation; Male; Postoperative Complications; Research NIH Extramural; Risk Factors; Virus Diseases
Abstract:
Infections now exceed rejection as a cause of hospitalization in the first 2 years post-renal transplantation. We analyzed data from the North American Pediatric Renal Transplant Cooperative Study (NAPRTCS) to determine risks for hospitalization for infection (HI), either bacterial (HBI) or viral (HVI). 3106 children transplanted between 1996 and 2002 with 2-year follow-up were analyzed. Univariate and multivariate logistic regression analyses identified factors for cause-specific hospitalization. Results: 23.4% experienced HBI, 23.9% HVI; 8.9% were hospitalized for both. Children 0-1 years age at transplant had higher rates of HI (64.2%), HBI (40.3%) and HVI (43.3%) compared to >12 years (31%, 17.5% and 18.9%, p < 0.0001). In comparison to no induction, patients receiving monoclonal or polyclonal antibody were more likely to have HI (>42% vs. 34.0%), HBI (>24% vs. 21%) or HVI (>29% vs. 21%, all p < 0.003) but had equivalent graft survival (p = NS). Higher rates of HI, HBI and HVI were also seen with prophylactic antimicrobial use and with >5 transfusions pretransplant. Since antibody induction in recent era was not associated with better graft or patient survival but was associated with more HI and HVI, the need for routine antibody induction in children needs to be reassessed.
