1. PATIENT-GRAFT SURVIVAL ANALYSIS IN KIDNEY TRASPLANT WITH DECEASED DONOR IN CHILDREN IN ARGENTINA 1998-2009 Bisigniano Liliana MD., López-Rivera Arturo MD., Tagliafichi Viviana, Fernández Víctor J MD., Soratti Carlos A MD.

2. Introduction Thanks to advances in surgical techniques and immune system suppression, the mortality rate in children with chronic renal failure has dramatically declined. Kidney transplantation has become the standard of care for ESRD in the pediatric population

3. Objective To analyze the variables included in organ procurement, retrieval and transplantation associated to both patient and graft survival in kidney transplant using deceased donors in patients under 18 years of age.

4. Materials & Methods The information was obtained from SINTRA for the period 1998-2009. The Kaplan-Meir method was used; survival at 30 days, 1, 5 and 10 yrs. was recorded. The Cox regression model was used to consider the variables for both patient and graft survival such as gender and age The MedCalc and SPSS 17 statistical packages were used

5. Materials & Methods Independent Variables Gender Donor´s Age Recipient´s Age CIT 24 hs Etiology of ERSD Time on Dialysis ( 7 yrs.) Cause of Donor´s Death Mismatch HLA from 0 to 6

6. Results Survival GENDER345 (54%) FEMALES AND 290 (46%) MALES AGE12.5+ 3.9 years MEAN FOLLOW UP4 YEARS (MAX 13 YEARS) PATIENTGRAFT 30 days 99.4%97.2% 1 st year 96.8%91.9% 5 years 91.1%79.3% 10 years 82.5%61.8%

7. Results Patient Survival Curve 30 days1 year5 years10 years 99.40%96.80%91.10%82.50%

8. Results Graft Survival Curve 30 days1 year5 years10 years 97.20%91.90%79.30%61.80%

9. Results Cox regression – patient survival VARIABLEHRIC 95%P Donor`s age 18-44 years0.670.37-1.260.227 Donor`s age 45-59 years1.220.51-2.920.654 Donor`s age >60 years--- Recipient`s age >12 years2.051.13-3.700.018 CIT > 24 hrs0.630.36-1.110.635 Obstructive nephropathy1.260.60-2.650.539 Glomerulonephritis1.080.53-2.200.843 Unknown0.690.25-1.900.474 Uremic Hemolytic Syndrome1.090.37-3.230.879 Renal polycystosis2.310.53-10.080.975 Interstitial tubulonephritis--- CVA1.200.61-2.350.605 Anoxia0.370.05-2.950.345 Other cause of coma1.440.33-6.340.629 Tumor14.993.92-57.35<0.0001 CNS infections--- Time on dialysis >7 years0.640.36-1.110.110 Female recipient1.831.06-3.160.029 Female donor1.891.08-3.330.026

10. Results Cox regression – patient survival VARIABLEHRIC 95%P Donor`s age 18-44 years0.670.37-1.260.227 Donor`s age 45-59 years1.220.51-2.920.654 Donor`s age >60 years--- Recipient`s age >12 years2.051.13-3.700.018 CIT > 24 hrs0.630.36-1.110.635 Obstructive nephropathy1.260.60-2.650.539 Glomerulonephritis1.080.53-2.200.843 Unknown0.690.25-1.900.474 Uremic Hemolytic Syndrome1.090.37-3.230.879 Renal polycystosis2.310.53-10.080.975 Interstitial tubulonephritis--- CVA1.200.61-2.350.605 Anoxia0.370.05-2.950.345 Other cause of coma1.440.33-6.340.629 Tumor14.993.92-57.35<0.0001 CNS infections--- Time on dialysis >7 years0.640.36-1.110.110 Female recipient1.831.06-3.160.029 Female donor1.891.08-3.330.026

11. RESULTS VARIABLEHRIC 95%P Donor`s age 18-44 years1.010.67-1.500.981 Donor`s age 45-59 years2.521.42-4.470.002 Donor`s age >60 years2.560.33-19.990.372 Recipient`s age >12 years1.210.84.1.730.303 CIT > 24 hrs1.591.11-2.280.012 Obstructive nephropathy1.140.68-1.910.627 Glomerulonephritis1.711.09-2.770.012 Unknown0.970.51-1.830.992 Uremic hemolytic syndrome1.120.55-2.310.752 Renal polycystosis2.551.00-6.510.051 Interstitial tubulonephritis1.360.32-5.730.678 CVA1.340.86-2.100.197 Anoxia1.360.53-3.500.530 Other cause of coma4.281.27-14.370.019 Tumor--0.967 CNS infections--- Time on dialysis >7 years1.591.11-2.280.018 Female recipient1.100.78-1.560.581 Female donor1.250.87-1.800.234 Cox regression – graft survival

12. Conclusions Female gender as a donor or recipient, a recipient older than 12 and a tumor as the cause of death were associated with a worse survival rate for recipient. The donor´s age between 45 and 59 yrs., the presence of glomerulonephritis as the etiology of renal failure, CIT > 24hrs and time on dialysis >7 yrs. were associated with a lower graft survival rate.

13. Thank you for your attention