Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

Blood condition is highly predictive of graft failure in pediatric kidney transplant

19.07.2012
For children receiving kidney transplants, a potentially correctable blood condition present in about one in four recipients is associated with a moderately increased risk of the graft's later failure, suggesting that clinicians should weigh whether transplant is advisable when the condition is present, according to UC Davis research presented today at the 24th International Congress of the Transplantation Society in Berlin.

Children with chronic kidney disease often have the condition, called low serum albumin, as a result of inflammation or malnutrition, among other causes. The research found that low serum albumin is an independent risk factor for higher rates of morbidity and mortality among pediatric kidney transplant recipients.

Roughly one in 65,000 children develop end-stage renal disease each year, and kidney transplant is the primary method for treating the condition in the pediatric population. The research was conducted by Lavjay Butani, professor and chief of the Division of Pediatric Nephrology, and Daniel Tancredi, a biostatistician and assistant professor in the UC Davis School of Medicine.

"Even a single low serum albumin measurement at the time of listing the patient on a transplant registry is clearly a risk factor for graft failure in the future," Butani said. "Transplant centers should very carefully consider proceeding with the transplant in children with very low serum albumin, because of its association with a moderately higher risk of graft failure."

"The transplant team, including the family and the patient, should be very cautious," he added.

During the past 30 years, the numbers of children and adolescents with end-stage renal disease has grown dramatically, according to the U.S. Centers for Disease Control and Prevention (CDC). In 1980 there were 738 persons with kidney failure under 20 years old in the United States. In 2008, the number had grown to 7,216, a 1,000 percent increase, CDC data shows.

Butani said that prolonging graft survival is key, since longer graft survival translates into fewer patients needing re-transplants. This is a benefit that is underappreciated among non-transplant providers, and is paramount in helping reduce the ever-growing disparity between patients on the wait list and those receiving transplants, he said.

Serum albumin is the most abundant protein in blood plasma and important for growth, wound healing and adequate circulation. When albumin levels are low, clinicians are divided about whether the transplant should be delayed until albumin levels can be increased.

Earlier studies in pediatric patients suggest that the longer a patient is on dialysis prior to the transplant, the poorer the long-term survival of the kidney that is eventually transplanted. On the other hand, low serum albumin levels at the time of transplant could lead to a higher risk of post-operative complications.

To assess whether post-transplant outcomes are worse in patients with lower pre-transplant albumin levels, the UC Davis researchers reviewed the records of approximately 6,000 children in the United States who received their first kidney transplant through the Organ Procurement and Transplantation Network between January 2000 and December 2010. The study examined a variety of factors, including recipient and donor demographics and pre-operative serum albumin at the time of registration.

The transplant recipients were an average of 10.9 years old at the time of transplant; approximately 48 percent received living donor transplants. Fifty-three percent were Caucasian, 23 percent were Hispanic and 19 percent were African American. Approximately 5 percent had very low serum albumin levels (less than 2.5 grams per deciliter) and their risk of graft failure within one year was 8.3 percent, almost double the risk observed in the children with the highest serum albumin levels. The approximately 20 percent of children with intermediate serum albumin levels (between 2.5 and 3.5 grams per deciliter) had an observed one-year graft failure risk of 6.2 percent.

The study found that serum albumin levels were inversely associated with time-to-graft failure. In other words, each gram-per-deciliter increase in serum albumin was associated with a 20 percent reduction in the hazard of graft failure over an average follow-up time of four years, after accounting for other factors.

The dilemma that these results raise is whether the low albumin levels actually are a cause of poorer graft survival, or simply a reflection of something else going on in the patient's body.

"Until then, for a child with chronic kidney disease who has a low serum albumin level, the presence of a modestly elevated potential risk of graft failure is something that will need to be discussed with the patient, the family and the entire transplant team," Butani said.

The research also identified marked regional variations in the prevalence of very low serum albumin levels among children who received transplants at the time of registration. The prevalence of very low serum albumin levels prior to the transplant was more than twice as high in the southeastern United States than in the west or southwest, a reflection of different practice patterns within the U.S. transplant community and one that merits further investigation.

"Although our study can assess whether an association exists, further research is necessary to determine if there is a cause-effect relationship," Tancredi said.

UC Davis Children's Hospital is the Sacramento region's only nationally ranked, comprehensive hospital for children, serving infants, children, adolescents and young adults with primary, subspecialty and critical care. It includes the Central Valley's only pediatric emergency department and Level 1 pediatric trauma center, which offers the highest level of care for critically ill children. The 129-bed children's hospital includes the state-of-the-art 49-bed neonatal and 24-bed pediatric intensive care and pediatric cardiac intensive care units. With more than 120 physicians in 33 subspecialties, UC Davis Children's Hospital has more than 74,000 clinic and hospital visits and 13,000 emergency department visits each year. For more information, visit children.ucdavis.edu.

Phyllis Brown | EurekAlert!
Further information:
http://www.ucdmc.ucdavis.edu

More articles from Health and Medicine:

nachricht 3D images of cancer cells in the body: Medical physicists from Halle present new method
16.05.2018 | Martin-Luther-Universität Halle-Wittenberg

nachricht Better equipped in the fight against lung cancer
16.05.2018 | Friedrich-Alexander-Universität Erlangen-Nürnberg

All articles from Health and Medicine >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Explanation for puzzling quantum oscillations has been found

So-called quantum many-body scars allow quantum systems to stay out of equilibrium much longer, explaining experiment | Study published in Nature Physics

Recently, researchers from Harvard and MIT succeeded in trapping a record 53 atoms and individually controlling their quantum state, realizing what is called a...

Im Focus: Dozens of binaries from Milky Way's globular clusters could be detectable by LISA

Next-generation gravitational wave detector in space will complement LIGO on Earth

The historic first detection of gravitational waves from colliding black holes far outside our galaxy opened a new window to understanding the universe. A...

Im Focus: Entangled atoms shine in unison

A team led by Austrian experimental physicist Rainer Blatt has succeeded in characterizing the quantum entanglement of two spatially separated atoms by observing their light emission. This fundamental demonstration could lead to the development of highly sensitive optical gradiometers for the precise measurement of the gravitational field or the earth's magnetic field.

The age of quantum technology has long been heralded. Decades of research into the quantum world have led to the development of methods that make it possible...

Im Focus: Computer-Designed Customized Regenerative Heart Valves

Cardiovascular tissue engineering aims to treat heart disease with prostheses that grow and regenerate. Now, researchers from the University of Zurich, the Technical University Eindhoven and the Charité Berlin have successfully implanted regenerative heart valves, designed with the aid of computer simulations, into sheep for the first time.

Producing living tissue or organs based on human cells is one of the main research fields in regenerative medicine. Tissue engineering, which involves growing...

Im Focus: Light-induced superconductivity under high pressure

A team of scientists of the Max Planck Institute for the Structure and Dynamics of Matter (MPSD) at the Center for Free-Electron Laser Science in Hamburg investigated optically-induced superconductivity in the alkali-doped fulleride K3C60under high external pressures. This study allowed, on one hand, to uniquely assess the nature of the transient state as a superconducting phase. In addition, it unveiled the possibility to induce superconductivity in K3C60 at temperatures far above the -170 degrees Celsius hypothesized previously, and rather all the way to room temperature. The paper by Cantaluppi et al has been published in Nature Physics.

Unlike ordinary metals, superconductors have the unique capability of transporting electrical currents without any loss. Nowadays, their technological...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

VideoLinks
Industry & Economy
Event News

Save the date: Forum European Neuroscience – 07-11 July 2018 in Berlin, Germany

02.05.2018 | Event News

Invitation to the upcoming "Current Topics in Bioinformatics: Big Data in Genomics and Medicine"

13.04.2018 | Event News

Unique scope of UV LED technologies and applications presented in Berlin: ICULTA-2018

12.04.2018 | Event News

 
Latest News

Supersonic waves may help electronics beat the heat

18.05.2018 | Power and Electrical Engineering

Keeping a Close Eye on Ice Loss

18.05.2018 | Information Technology

CrowdWater: An App for Flood Research

18.05.2018 | Information Technology

VideoLinks
Science & Research
Overview of more VideoLinks >>>