Impact of non-compliance on outcome after pediatric kidney transplantation: An analysis in racial subgroups

Renal transplantation is the therapy of choice for children with end-stage renal disease. Despite excellent patient survival, long-term graft survival is poor, especially in the African-American (AA) population. This article addresses non-compliance as a major cause of late-term graft loss in the pediatric population. Between July 1995 and September 2002, a total of 50 pediatric kidney transplants were performed at our institution. We have analyzed data for 44 of these kidney transplants. Twelve recipients were AA, 14 Caucasian (C) and 18 Hispanic (H). The remaining six patients of different racial origin were not included in this analysis. The mean age of the recipients was 10.9 yr (range 1.7-17.8). Thirty-one were cadaveric and 13 were living donor transplants. We analyzed creatinine level and graft and patient survival at 1, 3 and 5 yr post-transplant. Compliance was evaluated based on trends in cyclosporine levels, attendance to clinic visits, individual interviews and unexplained late graft dysfunction. One- and 3-yr patient survival rates were 100% for all racial groups, except the 3-yr patient survival rate for C, which was 86%. One and 3-yr graft survival rates for AA, C and H were 92 and 67%, 86 and 79% and 100 and 100%, respectively. However, at 5 yr, we found that AA recipients had a significantly higher rate of graft loss when compared to both H and C recipients (42 vs. 95 vs. 71%, respectively). Non-compliance was the main factor, accounting for 71% of cases of late graft loss. In conclusion, non-compliance is a problem of great importance in the pediatric transplant population, particularly in AA recipients, where it plays a major role in late-term graft loss.