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 Unique brain 'fingerprint' can predict drug effectiveness
11.07.2018 | McGill University

nachricht Direct conversion of non-neuronal cells into nerve cells
03.07.2018 | Universitätsmedizin der Johannes Gutenberg-Universität Mainz

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: First evidence on the source of extragalactic particles

For the first time ever, scientists have determined the cosmic origin of highest-energy neutrinos. A research group led by IceCube scientist Elisa Resconi, spokesperson of the Collaborative Research Center SFB1258 at the Technical University of Munich (TUM), provides an important piece of evidence that the particles detected by the IceCube neutrino telescope at the South Pole originate from a galaxy four billion light-years away from Earth.

To rule out other origins with certainty, the team led by neutrino physicist Elisa Resconi from the Technical University of Munich and multi-wavelength...

Im Focus: Magnetic vortices: Two independent magnetic skyrmion phases discovered in a single material

For the first time a team of researchers have discovered two different phases of magnetic skyrmions in a single material. Physicists of the Technical Universities of Munich and Dresden and the University of Cologne can now better study and understand the properties of these magnetic structures, which are important for both basic research and applications.

Whirlpools are an everyday experience in a bath tub: When the water is drained a circular vortex is formed. Typically, such whirls are rather stable. Similar...

Im Focus: Breaking the bond: To take part or not?

Physicists working with Roland Wester at the University of Innsbruck have investigated if and how chemical reactions can be influenced by targeted vibrational excitation of the reactants. They were able to demonstrate that excitation with a laser beam does not affect the efficiency of a chemical exchange reaction and that the excited molecular group acts only as a spectator in the reaction.

A frequently used reaction in organic chemistry is nucleophilic substitution. It plays, for example, an important role in in the synthesis of new chemical...

Im Focus: New 2D Spectroscopy Methods

Optical spectroscopy allows investigating the energy structure and dynamic properties of complex quantum systems. Researchers from the University of Würzburg present two new approaches of coherent two-dimensional spectroscopy.

"Put an excitation into the system and observe how it evolves." According to physicist Professor Tobias Brixner, this is the credo of optical spectroscopy....

Im Focus: Chemical reactions in the light of ultrashort X-ray pulses from free-electron lasers

Ultra-short, high-intensity X-ray flashes open the door to the foundations of chemical reactions. Free-electron lasers generate these kinds of pulses, but there is a catch: the pulses vary in duration and energy. An international research team has now presented a solution: Using a ring of 16 detectors and a circularly polarized laser beam, they can determine both factors with attosecond accuracy.

Free-electron lasers (FELs) generate extremely short and intense X-ray flashes. Researchers can use these flashes to resolve structures with diameters on the...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

VideoLinks
Industry & Economy
Event News

Leading experts in Diabetes, Metabolism and Biomedical Engineering discuss Precision Medicine

13.07.2018 | Event News

Conference on Laser Polishing – LaP: Fine Tuning for Surfaces

12.07.2018 | Event News

11th European Wood-based Panel Symposium 2018: Meeting point for the wood-based materials industry

03.07.2018 | Event News

 
Latest News

Microscopic trampoline may help create networks of quantum computers

17.07.2018 | Information Technology

In borophene, boundaries are no barrier

17.07.2018 | Materials Sciences

The role of Sodium for the Enhancement of Solar Cells

17.07.2018 | Power and Electrical Engineering

VideoLinks
Science & Research
Overview of more VideoLinks >>>