Akademik Veri Yönetim Sistemi
PEDIATRIC NEPHROLOGY, 2026 (SCI-Expanded, Scopus)
Background The medical management of failing kidney allografts is poorly understood even in adult patients with wide variations in practice. We studied failing kidney allografts in European children and provided insights into their management, including cardiovascular, CKD management, and changes to immunosuppression. Methods A 3-year (2020-2023) retrospective study of current practices in the management of children with failing kidney allografts (with at least 1 year of follow-up) was conducted. A failing kidney allograft was defined as an eGFR < 30 mL/min/1.73 m2 for 3 consecutive months, as agreed through an iterative Delphi process. All children who had a kidney transplant performed at < 18 years of age with a failing kidney allograft were included. Data were collected through the CERTAIN (Cooperative European Pediatric Renal Transplant Initiative) registry. Pearson correlation and Spearman's rank were used for continuous variables. Multivariate Cox proportional hazards models estimated associations of exposure with outcome. All statistical analyses were performed using Stata Version 16.0. Results A total of 119 patients from 27 European centres were included. At the time of allograft failure, 76% of patients were hypertensive, with 69% on antihypertensive medication(s). Of patients, 12%, 65%, and 29% were hyperphosphatemic, anemic, or acidotic, respectively. Phosphate binders, vitamin D analogs, iron supplementation, erythropoietin-stimulating agents, and alkali supplementation were used in 36%, 78%, 58%, 46%, and 71%, respectively. A variable practice of changing immunosuppressive drugs (at variable time points) after allograft failure was observed. At last follow-up, 47% of patients still had residual transplant function, 46% were on dialysis, 6% were re-transplanted, and 1% had died. Conclusions Management of children with failing kidney allografts is complex and practice varies across Europe. Our study paves the way for prospective studies looking at the effects of optimal management of blood pressure and CKD-MBD on allograft survival and the effects of immunosuppression changes on prospects for re-transplantation.