Age-Related Differences in Rejection Rates, Infections, and Tacrolimus Exposure in Pediatric Kidney Transplant Recipients in the CERTAIN Registry
Year: 2024
Type: article
Study design: Observational Study
Abstract: Introduction Data on age-related differences in rejection rates, infectious episodes and tacrolimus exposure in pediatric kidney transplant recipients (pKTR) on a tacrolimus-based immunosuppressive regimen are scarce. Methods We performed a large-scale analysis of 802 pKTR from the CERTAIN registry from 40 centers in 14 countries. Inclusion criteria were a tacrolimus-based immunosuppressive regimen and at least two years of follow-up. The patient population was divided into three age groups (infants and young children <6 years, school-aged children 6-12 years, and adolescents >12 years) to assess age-related differences in outcome. Results Median follow-up was 48 months (IQR, 36-72). Within the first 2 years post-transplant, infants and young children had a significantly higher incidence of infections (80.6% vs. 55.0% in adolescents, P<0.001) and a significantly higher number of cumulative hospital days (median 13 days vs. 7 days in adolescents, P < 0.001). Adolescents had a significantly higher rate of biopsy-proven acute rejection episodes in the first year post-transplant (21.7%) than infants and young children (12.6%, P=0.007). Infants and young children had significantly lower tacrolimus trough levels, lower tacrolimus concentration-to-dose ratios as an approximation for higher tacrolimus clearance, and higher tacrolimus intra-patient variability (all P < 0.01) than adolescents. Conclusions This largest study to date in European pKTR on a tacrolimus-based immunosuppressive regimen shows important age-related differences in rejection rates, infection episodes, tacrolimus exposure and clearance. These data suggest that immunosuppressive therapy in pKTR should be tailored and personalized according to the age-specific risk profiles of this heterogeneous patient population. The data may also serve as a benchmark for future studies with novel immunosuppressive drugs.
Source: Kidney International Reports
Authors: Maral Baghai Arassi, Manuel Feißt, Kai Krupka, Atif Awan, Elisa Benetti, Ali Düzova, Isabella Guzzo, Jon Jin Kim, Birgitta Kranz, Mieczysław Litwin, Jun Oh, Anja Büscher, Lars Pape, Licia Peruzzi, Mohan Shenoy, Sara Testa, Lutz T. Weber, Jakub Zieg, Britta Höcker, Alexander Fichtner, Burkhard Tönshoff
Institutions: Heidelberg University, University Hospital Heidelberg, European Molecular Biology Laboratory, European Molecular Biology Laboratory, Temple Street Children's University Hospital, Azienda Ospedale - Università Padova, Hacettepe University, Bambino Gesù Children's Hospital, Istituti di Ricovero e Cura a Carattere Scientifico, Nottingham University Hospitals NHS Trust, University of Münster, University Hospital Münster, Children's Memorial Health Institute, Universität Hamburg, University Medical Center Hamburg-Eppendorf, Essen University Hospital, Azienda Ospedaliera Citta' della Salute e della Scienza di Torino, Ospedale Regina Margherita, Royal Manchester Children's Hospital, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Cologne, University Hospital Cologne, Charles University, University Hospital in Motol
Language: English
Subfield: Transplantation
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,800
Funder: Astellas Pharma
OpenAlex ID: W4402126431