Long term outcomes of renal transplantation in children at tripoli children hospital

Background: Kidney transplantation is the optimal treatment for end-stage renal disease in children. However, long-term graft survival has not significantly improved among paediatric patients. Objective: To investigate the determinants of long-term graft survival among Libyan paediatric recipients of kidney transplantation. Methods: In a single-centre cohort study, we studied 31 paediatric kidney transplantations performed from 2000-2019, fallow up with nephrology clinic at Tripoli Children Hospital, Tripoli, Libya. Different variables were collected for each patient and graft survival rates were calculated. Results: After a follow-up period of 15.8 (±4.0) years, the graft survival rate was 14.5(±0.5) years; the 1-, 5-, 10-, and 20-year mean graft survival rates were 90%, 81%, 62%, and 62%, respectively. The corresponding patient survival rates were 100%, 99.4%, 97.8%, and 96.5%, respectively. Pre-emptive transplantation (p=0.006) and living graft donation (p=0.002) led to higher graft survival, while primary disease of primary hyperoxaluria (p=0.001) led to lower graft survival. Chronic rejection was the most frequent cause of graft loss. Conclusion: Short-term graft survival still outpaces the long-term outcome. Modifying the mentioned determinants, with more intense immunosuppression for greater prevention of acute and chronic rejection, and increased rate of pre-emptive transplantation and living donor transplantation, long-term graft survival may significantly improve in future.