Etiological and Clinical Evaluations Of Patients With Acute Allograft Dysfunction Within The First Year

INTRODUCTION: Kidney transplantation is the most preferred long-term treatment of children with end stage renal disease since 1954. Graft dysfunction has been divided into three categories based on timing of presentation. In this article, we aim to present the etiologic factors of acute graft dysfunction in the first year of renal transplantation in children.
METHODS: The patients, diagnosed with acute allograft dysfunction in first year of kidney transplantation, in Izmir Tepecik Research Hospital between March 2005 and October 2017 were analyzed prospectively in this study.
RESULTS: Over the 15 year period, 56 pediatric renal allograft patients were followed in Izmir Tepecik Training and Research Hospital. During this period, 25 patients had diagnosed with early allograft dysfunction. Five patients were admitted two times in a year with allograft dysfunction. The mean age of patients was 12.6 (4.0±21.0) years, with a male and female ratio of 17: 8. Delayed graft function was occurred in four patients (16%). Among 25 renal allograft recipients showed early graft dysfunction on average of 4.2 months (1-10 months) after transplantation. The etiology of early graft dysfunction showed 10% immunologic diseases and 90% nonimmunologic factors. Five patients (16,7%) diagnosed with urinary tract infection, one patient (3,3%) diagnosed with CMV nephropathy, five patients (16,7%) diagnosed with BK nephropathy, eight patients (26,7%) diagnosed with acute cyclosporine toxicity, seven patients (23,3%) were diagnosed with dehydration and one patient (3,3%) diagnosed with urologic anomalies. Twelve patients had performed renal allograft biopsy. The histological findings were consistent with T cell mediated rejection in two patients; B cell mediated rejection in one patient and viral nephropathy in five patients. Nonspecific histological findings were determined in five patients.
DISCUSSION AND CONCLUSION: Early recognition of the etiology of graft dysfunction that develops at 1 year and appropriate treatment will contribute to the preservation of long-term graft dysfunction.