Acute rejection after pediatric kidney transplantation at Queen Rania Abdullah Hospital for children Jordan

الملخص EN

Objective: Acute kidney rejection (AKR) is considered one of the most importantmedical post-transplant complications.

It is associated with significant percentage of graft outcome of our patients with AKR.Our aim of this study is to clarify our center incidence of acute rejection and to discuss our experience in treatment of acute rejection.

Methods: This is a retrospective chart review study conducted in Queen Rania Abdallah Hospital for children which is a referral center in Jordan for pediatric kidney transplant, for all children who underwent kidney transplant and followed by the nephrology department over a period extended between 2004 and 2018.

The age of patients ranged from 4-14 years.

We studied the files of all the transplanted patients and who developed AKR.

The following data were recorded: age of patients at the time of kidney transplant, sex, the primary disease, relation to the donor, time when acute rejection developed after kidney transplant, and being preemptive transplant or not.

Signs and symptoms at the presentation, creatinine level post rejection, histopathologic features on kidney biopsy, immunosuppressant drugs post kidney transplant and the treatment modalities of acute rejection all were reported for each patient.

The outcome of the treatment in the form of graft loss and the mortality were reported in the study.

Results: The total number of patients who received kidney transplant during the last 15 years from 2004-2018 was 127.

With male to female ratio was 1.2:1.

24 patients (18.9%) developed acute rejection (AR).

Acute cellular rejection (ACR) accounts for 79.2% (19 patients) while acute antibody mediated rejection (a AMR) 20.8% (5 patients).

Mean age of kidney transplant patients was 10.2±3.6years.

The most common primary causes that end up with acute cellular rejection were neurogenic bladder (33.3%), focal segmental glomerulosclerosis (23.8%).

The acute mediated antibody rejection was seen in 3 patients with focal segmental glomerulosclerosis and in 2 patients with reflux nephropathy.

33% of patients with AR lost their grafts and mortality rate was 12.5%.

Conclusion: Acute kidney rejection is a serious complication post kidney transplant.

Early diagnosis and compliance to treatment have a great impact on the outcome of AR