Teens show highest rate of kidney transplant failure

Patients who received their first kidney transplant at ages 14 to 16 years appear to be at increased risk for transplant failure, with African-American adolescents having a disproportionately higher risk of graft failure, new research shows.

Kenneth A. Andreoni, MD, of the University of Florida, Gainesville, and colleagues analyzed 168,809 first kidney-only transplants from October 1987 through October 2010. Age at transplant was the primary factor studied.

“Adolescent recipients aged 14 to 16 years had the highest risk of any age group of graft loss … starting at one year after transplant, and amplifying at three, five and 10 years after transplant,” according to the study results, published online in JAMA Internal Medicine (July 29, 2013). “Black adolescents are at a disproportionate risk of graft failure at these time points compared with nonblack adolescents.”

In the study, Dr. Andreoni and colleagues also note that donor type (deceased vs. living) and insurance type (government vs. private) also had an impact along with a kidney transplant recipient’s age.

“Among 14-year-old recipients, the risk of death was 175% greater in the deceased donor-government insurance group vs. the living donor-private insurance group (hazard ratio, 0.92 vs. 0.34), whereas patient survival rates in the living donor-government insurance and deceased donor-private insurance groups were nearly identical (hazard ratio, 0.61 vs. 0.54),” the authors wrote.

Researchers suggest that comprehensive programs are needed for adolescent transplant recipients.

“The realization that this age group is at an increased risk of graft loss as they are becoming young adults should prompt providers to give specialized care and attention to these adolescents in the transition from pediatric to adult-focused care,” they wrote. “Implementing a structured health care transition preparation program from pediatric to adult-centered care in transplant centers may improve outcomes.”

To get weekly news from the leading news source for urologists, subscribe to the Urology Times eNews.