Practice Patterns and Outcomes for Pediatric ANCA Vasculitis Transplant Recipients in a National Cohort

Authors

Stella Kilduff, Maria Fareri Children's Hospital, Westchester Medical Center, New York Medical College, Valhalla, NY, USA.
Jonathan Butler, Department of Surgery, Clinical Research Unit, Westchester Medical Center, Valhalla, NY, USA.
Hiroshi Sogawa, Department of Surgery, Division of Intra-Abdominal Transplant & Hepatobiliary Surgery, Westchester Medical Center, New York Medical College, Valhalla, NY, USA.
Sonia Solomon, Maria Fareri Children's Hospital, Westchester Medical Center, Boston Children's Health Physicians, New York Medical College, Valhalla, NY, USA. ssolomon20@nymc.edu.Follow

Author Type(s)

Faculty

DOI

10.1007/s00467-021-05341-z

Journal Title

Pediatric Nephrology

First Page

1667

Last Page

1673

Document Type

Article

Publication Date

7-1-2022

Department

Surgery

Second Department

Pediatrics

Abstract

BACKGROUND: Anti-neutrophil cytoplasmic autoantibody (ANCA) vasculitis is a rare condition in pediatric patients. Little is known about practice patterns and outcomes of pediatric transplant patients. The purpose of our study was to examine differences in patient characteristics, immunosuppression, and long-term graft outcomes between ANCA and non-ANCA vasculitis recipients. METHODS: We used the Scientific Registry of Transplant Recipients to evaluate pediatric ANCA vasculitis recipients between the ages of 1 and 22 years old from 1991 to 2017 and compared them to non-ANCA vasculitis patients during the same time cohort in the USA. RESULTS: A total of 26,431 transplant recipients were identified, of these, 337 with ANCA vasculitis. Mean 1-year eGFR was 62.46 and 64.92 ml/min/1.73 m (p = 0.002), and mean 5-year eGFR was 57.95 and 59.38 ml/min/1.73 m (p = 0.18) between the non-ANCA and ANCA groups, respectively. Five-year graft survival was similar in both groups (non-ANCA 75.5 vs. ANCA 78.6%; p = 0.19). Of those with graft loss within the ANCA group, only 0.6% was secondary to disease recurrence (p = 0.14). CONCLUSIONS: Kidney transplant is a safe treatment modality for children with ANCA-related kidney failure. ANCA patients have comparable graft survival when compared to the general transplant population with a low risk of recurrence. Thymoglobulin was used in a higher proportion within the ANCA group compared to the non-ANCA group. Tacrolimus, mycophenolate mofetil/mycophenolic acid, and steroids were the predominant maintenance immunosuppression used in both groups. A higher resolution version of the Graphical abstract is available as Supplementary information.

Recommended Citation

Kilduff, S., Butler, J., Sogawa, H., & Solomon, S. (2022). Practice Patterns and Outcomes for Pediatric ANCA Vasculitis Transplant Recipients in a National Cohort. Pediatric Nephrology, 37 (7), 1667-1673. https://doi.org/10.1007/s00467-021-05341-z