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Pediatr Transplant. 2018 Nov 11:e13321. doi: 10.1111/petr.13321. [Epub ahead of print]

The prevalence and outcome of children with failure to thrive after pediatric kidney transplantation.

Author information

1
Department of Nephrology, Children's National Health System, Washington, District of Columbia.
2
Department of Biostatistics and Study Methodology, Children's National Health System, Washington, District of Columbia.
3
Department of Pediatric Nephrology, Johns Hopkins Hospital and Health System, Baltimore, Maryland.

Abstract

BACKGROUND:

Prior to transplantation, effects of advanced CKD contribute to malnutrition and impaired growth. After transplant, children are expected to thrive, however, in a subset of transplant recipients this does not occur. Factors associated with post-transplant FTT are poorly understood.

OBJECTIVE:

A retrospective cohort study was conducted to determine factors associated with FTT and association of FTT with infections and hospitalizations.

METHODS:

Records of 119 children transplanted between 2005 and 2016 were reviewed. FTT was defined by ≥2 of the following post-transplant criteria: (a) low BMI or deceleration in BMI z-score, (b) poor growth velocity, and (c) chronic hypoalbuminemia at 1 or 3 years post-transplant. Association of FTT with deceased donor transplant, de novo DSA, intolerance to MMF, anemia, vitamin D deficiency, and CIC was investigated by logistic regression. Poisson regression was used to identify outcomes associated with FTT.

RESULTS:

Low pre-transplant BMI and post-transplant CIC dependence were independently associated with FTT after transplant. Odds of FTT at 1 year post-transplant decreased by 0.5 for each 1 unit increase in pre-transplant BMI z-score. Requirement for CIC conferred 3.8 and 7.8 higher odds of FTT at 1 and 3 years. Patients with FTT had 2.7 and 2.6 times infections and hospitalizations during the first year, and 4.2 and 4.3 times infections and hospitalizations over 3 years post-transplant.

CONCLUSIONS:

Children with low BMI prior to transplant and those requiring CIC after transplant are at increased risk for post-transplant FTT. FTT is associated with adverse outcomes, evidenced by increased infections and hospitalizations.

KEYWORDS:

body mass index; clean intermittent catheterization; growth; infection; mycophenolate mofetil; nutrition

PMID:
30417493
DOI:
10.1111/petr.13321

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