Pediatric Transplant Infections and Outcomes

儿科移植感染和结果

• 批准号: 7140407
• 负责人: Vikas R. Dharnidharka
• 金额: $ 14.21万
• 依托单位: UNIVERSITY OF FLORIDA
• 依托单位国家: 美国
• 财政年份: 2005
• 资助国家: 美国
• 起止时间: 2005-08-01 至 2007-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7140407
• 关键词: adolescence (12-20); autoimmune disorder; child (0-11); computer data analysis; disease /disorder proneness /risk; graft versus host disease; hospital utilization; human data; human mortality; kidney infection; kidney transplantation; longitudinal human study; lupus nephritis; lymphocyte proliferation; meta analysis; outcomes research; postoperative complications; pyelonephritis; statistics /biometry; transplantation immunology; virus diseases

DESCRIPTION (provided by applicant): Although transplant acute rejection rates have declined dramatically, in the most recent years, there have been almost no incremental gains in either short-term or longer-term graft survival (GS) rates (USRDS 2003 report). The applicants, in prior studies, have documented the rise in frequency in post-transplant infections (PTI; both bacterial and viral etiology) and post transplant lymphoproliferative disease (PTLD) in the uniquely susceptible pediatric population. There is a severe paucity of data regarding PTI trends and their impact on GS in children. In this proposal, the applicants will obtain data files from extremely large transplant databases (including USRDS and UNOS) on multiple transplantation variables, post transplant course, data on hospitalization, institutional billing claims for Medicare payment and patient death. These data will be analyzed to test the hypotheses that: 1) pediatric kidney transplant recipients are at greater risk for death due to PTI in months 6-36 as compared to adults; 2) hospitalization due to PTI, especially viral, is increasing in frequency in pediatric kidney transplant recipients in more recent cohorts; 3) this increase in hospitalization due to viral infections increases the risk of worse death-censored GS; 4) children who have received prior immunosuppression have a higher adjusted relative risk for post kidney transplant PTI and thus a reduced death-censored GS; 5) PTI involving the renal allograft itself (such as transplant pyelonephritis) represent an independent risk factor for reduced death-censored GS; 6) the relative risk of developing PTLD is higher in pediatric kidney transplant recipients who received induction therapy with daclizumab or basiliximab. These studies will set the stage for a) randomized prospective clinical trials on strategies to reduce PTI and result in improved GS; b) mechanistic studies that investigate how graft-directed immunity is affected by primary viral infections in pediatric kidney transplant recipients; c) development of a specific ICD-9 code for BK virus infection that will allow studies of its long-term effects.

描述（由申请人提供）：尽管移植急性排斥率急剧下降，但在近年来，短期或长期移植物存活率（GS）率几乎没有增量增长（USRDS 2003报告）。在先前的研究中，申请人已经证明了移植后感染（PTI；细菌和病毒病因学）和移植后淋巴增生性疾病（PTLD）的频率上升。关于PTI趋势及其对儿童GS的影响的数据严重缺乏。在此提案中，申请人将从多个移植变量，移植后课程，住院数据，医疗保险支付的机构账单和患者死亡的数据中获取大型移植数据库（包括USRD和UNOS）的数据文件。这些数据将进行分析，以检验：1）与成人相比，由于PTI在6-36个月中，小儿肾移植受者的死亡风险更大； 2）由于PTI，尤其是病毒，在较新的队列中，小儿肾移植受者的频率正在增加； 3）由于病毒感染而导致的住院增加会增加死亡经过死亡的GS的风险； 4）事先接受免疫抑制的儿童患肾后移植PTI的相对风险较高，从而减少了死亡经过死亡的GS； 5）涉及肾脏同种异体移植本身（例如移植肾上腺炎）的PTI代表了减少死亡的GS的独立危险因素； 6）在接受Daclizumab或basiliximab诱导疗法的小儿肾脏移植受者中，患PTLD的相对风险更高。这些研究将为a）关于减少PTI并改善GS的策略的随机前瞻性临床试验的阶段； b）调查小儿肾脏移植受者原发性病毒感染的原发性病毒感染如何影响移植物导向免疫的机理研究； c）开发针对BK病毒感染的特定ICD-9代码，该代码将允许研究其长期影响。

项目成果

Post-transplant lymphoproliferative disease: association with induction therapy?

移植后淋巴增殖性疾病：与诱导治疗相关吗？

• DOI: 10.2165/00003495-200666040-00003
• 发表时间: 2006
• 期刊: Drugs
• 影响因子: 11.5
• 作者: Dharnidharka,VikasR

Assessing the value of ureteral stent placement in pediatric kidney transplant recipients.

评估儿童肾移植受者输尿管支架置入的价值。

• DOI: 10.1097/tp.0b013e318169bf11
• 发表时间: 2008
• 期刊: Transplantation
• 影响因子: 6.2
• 作者: Dharnidharka,VikasR;Araya,CarlosE;Wadsworth,ChristopherS;McKinney,MichaelC;Howard,RichardJ
• 通讯作者: Howard,RichardJ