Beyond Survival: A 12-Year Chronicle of Pediatric Kidney Transplantation in Kazakhstan

Pediatric kidney transplantation (KTx) is a life-saving procedure for children with end-stage renal disease (ESRD), yet outcomes and risk factors remain underreported in Central Asia. We aimed to provide valuable insights into the long-term impact of KTx on pediatric patients.<br /> <b>Materials and methods</b>: This article presents a retrospective review of 12-year experience of pediatric KTx at the «University Medical Center» Corporate Fund (Astana, Kazakhstan). The analysis included the records of 146 patients under the age of 18. The characteristics of the patients included causes of chronic kidney disease (CKD), clinical features and transplantation outcomes: overall survival (OS), graft survival (GS), graft loss (GL), transplant rejection (TR) and complications.<br /> <b>Results:</b> Of 146 recipients (mean age 139 months, 56.8% male), the leading cause of ESRD was congenital anomalies of the kidney and urinary tract (CAKUT, 50.7%). Living donor KTx (LDKT) accounted for 73%, while Deceased donor KTx (DDKT). TR occurred in 18.5% of cases and was significantly associated with GL (OR = 7.19, 95% CI: 2.55-20.25, p < 0.001). GL occurred in 13.0% of patients, and mortality was 6.2%. Complications were reported in 43.8% of patients and were significantly associated with mortality (p = 0.034). No association between donor type (LDKT vs. DDKT) and rejection was found. Gender, diagnosis, BMI, age at transplantation, donor type were not significant predictors of GL or patient death.<br /> <b>Conclusion:</b> Pediatric KTx in Kazakhstan demonstrates promising outcomes, with relatively low mortality (6.2%) and GL (13.0%) rates. TR (occurred in 18.5% patients) significantly predicts GL, while post-Tx complications (occurred in43.8% of patients) are associated with decreased patient survival. These findings support the need for improved early monitoring and long-term management strategies to optimize outcomes.<br /> <b>Keywords: </b>kidney transplantation, child, graft loss, rejection, complication, survival analysis