ESPN 53rd Annual Meeting

ESPN 2021

Kidney transplant rejection and survival in adolescents – the Rotterdam experience
Femke Vrieling-Prince 1 Marian Clahsen-Van Groningen 2 Huib de Jong 1 Karlien Cransberg 1 Joke Roodnat 3

1- Department of Paediatric Nephrology and Erasmus MC Transplant Institute, Erasmus MC Sophia Children’s Hospital, Rotterdam
2- Department of Pathology and Erasmus MC Transplant Institute, Erasmus MC, Rotterdam
3- Department of Internal Medicine, Division of Nephrology and Erasmus MC Transplant Institute, Erasmus MC, Rotterdam

 Several registries report a higher risk of kidney transplant loss in adolescence compared to other age groups. The objectives of this study were to evaluate:

1.       -if adolescents have a higher risk of acute rejection

2.       -if adolescents have (early) transplant loss due to acute and/or chronic rejection.  

Material and methods:

This retrospective study was performed in pediatric and young adult kidney transplant recipients, receiving a first transplant between 1990-2018, at the age of 6-25 years(y), in the Erasmus MC Rotterdam. Patient files were searched for all for-cause graft biopsy reports, and cause of transplant failure and/or death. Biopsies were reevaluated according to the 2017 Banff Classification. 


 In 65(54%) of all pediatric and 85(65%) of all adult patients at least one transplant biopsy was obtained. Sixty seven (45%) patients had an acute rejection episode (ARE) in at least one biopsy, with the highest incidence in the 20-25y age group (27%, n=20) and the lowest incidence in the 6-10y group (16%, n=5).

ARE-free survival was best in the 6-10y group (n=32): 90% at 2y and 86% at 8y post-transplant, followed by the 10-15y group (n=49): 86% and 81%.  Older recipients showed a poorer ARE-free survival: in 15-20y group (n=94) of 86% at 2y and 68% at 8y post-transplant, and in the 20-25y group(n=75) of 84% and 65% (p=0.063).

Subsequently graft losses due to acute and/or chronic rejection were studied. Transplant survival was superior in the 6-10y group: 97% at 2y and 89% at 8y at post-transplant, followed by the 20-25y group: 97% and 85%. Inferior transplant survival was seen in the 10-15y group (96% and 67%) and in the 15-20y group (93% and 67%) (p=0.073).


 The youngest(6-10y) kidney transplant recipients had the lowest incidence of ARE, the oldest(20-25y) recipients the highest. Inferior transplant survival due to rejection was seen in the adolescent (10-20y)groups.