Outcome of pediatric renal transplantation in urological versus non-urological causes of end stage renal disease: Does it matter?

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Introduction Causes for end stage renal disease (ESRD) in children can be categorized into urological causes or non-urological causes. We sought to compare the outcomes of urological and non-urological causes of ESRD in children. Methods Patients were divided into two groups: urological causes of ESRD versus non-urological causes of ESRD. All patients and donors had at least 6 months of follow-up. The main outcomes included the effect on complications and renal function. Comparisons were carried out using the chi-square test or the Student t -test. Multivariate logistic regression analysis was used to define the effect of different variables on the outcome of renal transplantation (Table). Results Our study included 123 patients, 91 males. The mean age was 9 years and mean follow up was 46 months. Two-thirds of the patients had non-urological causes of ESRD. Overall survival was 100%, and only one patient needed a graft nephrectomy 3 months after the transplant. The mean estimated glomerular filtration rate was 117 mL/min, and did not differ significantly between the two groups ( p = 0.13). Multivariable regression showed that female gender (OR 8.7, 95% CI 2.9–26, p = 0 0.0001) was associated with better renal function, while having a urological cause of ESRD (OR 0.28, CI 0.08–0.98, p = 0 0.05) was associated with worse renal function. Non-urological causes of ESRD were significantly less likely to develop complications following renal transplantation (OR 0.28, CI 0.09–0.89, p = 0 0.03). Conclusion Female patients with non-urological causes of ESRD are more likely to have better long-term renal functions, and less liable to develop complications following renal transplant.TableMultivariable regression model (stepwise method) for prediction of factors that may affect the renal functions and postoperative complications following transplantation.VariableOdds ratio95% CIpRenal functionsSex8.72.90–26.000.0001Urological causes of ESRD0.280.08–0.980.05Postoperative complicationsNon-urological causes of ESRD0.280.09–0.890.03 Note. Factors included in the univariate analysis: age, sex, weight, cause of ESRD (urological vs. non-urological), pre-emptive transplantation, dialysis prior to transplantation, gender of donor, gender of recipient. CI = confidence interval; ESRD = end-stage renal disease.