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Kidney transplants not as successful among teens

By Genevra Pittman

NEW YORK (Reuters Health) - Teenagers who undergo a kidney transplant are more likely to have their new organ stop working within a few years than both younger and older recipients, according to a new study.

Researchers analyzed data on 169,000 kidney transplant recipients and found 14- to 16-year-olds had the highest risk of so-called graft loss starting one year after their transplant.

"There can be a dramatic change at the transplant event," said Dr. Kenneth Andreoni, who led the study at the University of Florida in Gainesville.

For example, he said, people often have to start taking up to ten or 12 new medications per day after a kidney transplant. That may be an especially difficult transition for teenagers.

"This is something where it's really hard for the children, and even adults, to really survive and do well when they're not doing the right thing," Andreoni told Reuters Health.

His team found black teens and those on government-run insurance were especially at risk of having their new organ fail.

According to the National Kidney Foundation, about 16,800 kidney transplants took place in the U.S. last year.

Kids and teens make up only a small proportion of all transplants, researchers said. Most often they have birth defects affecting the kidneys and bladder.

The new data, published in JAMA Internal Medicine, are based on national organ transplant records covering 1987 through 2010. Andreoni and his colleagues looked specifically at kidney transplant recipients age 55 and younger.

They found that during the study period, about 28 percent of transplanted kidneys stopped working. The average transplant lasted 13.6 years.

Compared to 40-year-old kidney recipients, for example, 15-year-olds were between 63 percent and 85 percent, depending on their insurance, more likely to have the transplant fail when their kidney came from a deceased donor.

When the kidney came from a living donor, such as a parent, teens were at a 13 percent to 53 percent greater risk of graft loss. The lower loss rate might be explained by the fact that with a living donor, there is typically more time to prepare for the surgery, researchers said.

Teenagers also had more graft failures than younger children.

Researchers said the findings do not mean teens shouldn't be given kidney transplants.

"An important caveat is that some (adolescents) do very well," said Dr. Matthew Levine, a transplant surgeon at the Hospital of the University of Pennsylvania in Philadelphia.

Teens that don't do as well, he told Reuters Health, may struggle to stick to a new medication regimen or get caught between different insurance plans or between child- and adult-centered care.

"Most people believe that at least part of the reason for the higher risk during adolescence is due to poor medication adherence," said Dr. Beth Foster, who has studied kidney transplants in children and teenagers at McGill University in Montreal, Canada, but like Levine was not involved in the new research.

"We don't know if there may be other reasons as well, such as potentially an enhanced immune response during adolescence" that would affect how the body accepts the new organ, she told Reuters Health.

Researchers are currently experimenting with ways to reach out to young transplant recipients, Foster said, such as with extra nursing support or text messages reminding them to take their medication.

Andreoni said doctors may need to take more time to teach teens and their families about the transplant process, especially poorer families and others who are less savvy with medical information.

"Especially the groups that may be more challenged, they simply need more time and more effort," he said.

SOURCE: http://bit.ly/19uP2cq JAMA Internal Medicine, online July 29, 2013.

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