BACKGROUND:The Collaborative Brazilian Pediatric Renal Transplant Registry started in 2004 as a multicenter initiative aiming to analyze, report, and share the results of pediatric kidney transplantation in Brazil. Data from all pediatric kidney transplants performed between January 2004 and December 2013 were recorded electronically and periodically updated. All patients under 18 years old from the participating centers were enrolled. Demographic data, etiology of chronic kidney disease, and patient and graft survival were analyzed. From a total of 2443 pediatric kidney transplants performed in Brazil during the study period, we report data from 1751 pediatric renal transplants performed in 13 centers enrolled in the collaborative study. Median age at transplantation was 12.4 years, and most of recipients were male (56%). The most common underlying renal etiologies were obstructive uropathy (31%) and glomerulopathy (26%).METHODS:According to donor source, 1155 (66%) of transplants were performed with deceased donors (DD). Initial immunosuppression consisted mainly of tacrolimus, mycophenolate, steroids, and induction therapy with anti-IL-2R antibodies.RESULTS:One-year graft survival (death-censored) was 93% and 90% (log rank test, P < .01), respectively, for living donor (LD) and DD. Graft losses (15%) were most frequently caused by vascular thrombosis, chronic allograft nephropathy, death with functioning kidney, acute rejection, and recurrent renal disease. Recipients of DD had 2.02 (95% confidence interval: 1.14-3.59) times the hazard of graft loss compared with those of LD (P = .015). Patient survival rates at 1 and 5 years were 98% and 97% for LD and 97% and 93% for DD, respectively. The mortality rate was 3.8%, mainly as the result of infection and cardiovascular disease.CONCLUSIONS:The results of this collaborative pediatric transplant study are comparable to international registries. Our effort has been able to maintain an exchange of information, both among the participating centers and with other international registries.

Aim: Latin-America Pediatric Renal Transplant Registry began in 2003. The objective is to analyze and share the results of pediatric kidney transplantation performed in Latin America. Methods: Data of pediatric renal transplants performed on patients from 43 centers in 14 countries: Argentina, Brasil, Chile, Colombia, Costa Rica, Cuba, Ecuador, Guatemala, Honduras, México, Nicaragua, Paraguay, Perú y Venezuela between January 1st, 2004 and December 31st, 2012 was collected. Results: Data on 2944 renal transplants were obtained. Mean age was 11.4+3.6 years, 57% male. Main etiology were congenital uropathy/vesicoureteral reflux (28%), followed by glomerulopathy (23%), including 326(11%) FSGS, hereditary diseases(14.7%), vascular diseases(3.1%), unknown in 17%. Sixty percent of transplants were performed with deceased donors and initial immunosuppression consisted mainly of tacrolimus (77%), mycophenolic acid(71%), steroids(96%) and induction therapy with anti- IL-2R antibodies (72%)One year graft survival was 97% and 87% (p<0,05), respectively for living donors (LD) and deceased donors (DD). Graft loss incidence was 16%, most frequently caused by (in descending order) acute and chronic rejection, arterial or venous thrombosis, death with functioning kidney and recurrent renal disease. Patient survival at 1 and 3 years was 96% and 95%, respectively. Mortality rate was 4% mainly due to infection and cardiovascular disease. Conclusion: The results are comparable to that of other international centers. Efforts are being made to provide on-line data entry, in order to facilitate reporting, and to supply an exchange of information, among the participating centers, as with other centers in the world.

OBJECTIVE: The Collaborative Brazilian Pediatric Renal Transplant Registry (COBRAPRTR) started in 2003 is a multicenter initiative which aims to analyze report and sharethe results of pediatric kidney transplantation in Brazil. METHOD: Data from all pediatric kidney transplants performed between January 2004 and December 2012 were recorded in an electronic sheet and periodically updated. All patients under 18 years old from the participating centers were enrolled. Demographic data, etiology of CKD, patient and graft survival were analyzed. RESULTS: From a total of 2443 pediatric kidney transplants performed in Brazil during the study period we report data from 1628 pediatric renal transplants performed in 13 centers enrolled in COBRAPRTR. Mean age at transplantation was 11.8±4.5 years and most of recipients were male (57%). The more frequent causes of kidney disease were congenital uropathy (31%), glomerulopathies (27%, from which FSGS accounted for 47%), hypoplasia/dysplasia (7%) and other causes (33%). Sixty two (62%) of transplants were performed with deceased donors and initial immunosuppression consisted mainly of tacrolimus, mycophenolate sodium, steroids and induction therapy with anti- IL-2R antibodies. One year graft survival were 94% and 88% (Log rank test p=0,0003), respectively for living donor (LD) and deceased donor (DD). There were 16% of graft losses more frequently caused by (in descending order) death with functioning kidney, recurrent renal disease, arterial or venous thrombosis, acute rejection, and chronic allograft nephropathy. Patient survival at 1 and 5 years with LD and DD were 94% and 84%, respectively. Mortality rate was 4% mainly due to infection and cardiovascular disease. CONCLUSIONS: In Brazil, efforts are being made to offer an online registry input of data in order to facilitate the report of pediatric kidney transplants. Information exchange, both among the participating centers and with other international registries is also warranted.

The Latin American Pediatric Nephrology Association (ALANEPE) reports the first regional kidney transplant registry in Latin America. A mean range of 75%, 30% to 100% renal transplant recipients under 21 yr old were included. Out of 20 countries invited to participate, 14 performed renal transplant, 11 had universal financial support from their governments. The centers included: Brazil (9), Argentina (4), Chile (4), Venezuela (3), Mexico (2), and one in: Cuba, Colombia, Costa Rica, Nicaragua, Guatemala, Ecuador, Honduras, Paraguay and Peru. The registry included 1458 patients, average of 291 per year, 55% male. Mean follow-up 23.4 +/- 17 months; mean age was 11.7 +/- 4.3 yr (1-21), 11% under five yr of age. Etiology: uropathy/ reflux nephropathy 27%, glomerulopathies 24% (included 12% FSGS), hypo/dysplasia (11%), vascular (6%), congenital/hereditary (5%), unknown (19%). Induction therapy: 71% anti-IL2RAb, 13% ATG/TIMO, 14% non-induction. Maintenance therapy: Tacrolimus 64%, Cyclosporine 32%, MMF 54%, MPS 20%, noTORi 96%, steroids 90%, withdrawal or steroid avoidance 10%. Loss of graft 155/1458 (11%), death with functioning graft (3.4%), vascular thrombosis (2.8%), acute rejection (2.8%), recurrence of disease (1%). Forty-eight patients died (3.3%); infection was the main cause 23 (2.1%). Global patient survival rate at one, three, and five yr was 97%, 96%, and 96%. Graft survival rate at one, three, and five yr LRD was 96%, 93% and 89%; for DD 92%, 86% and 76% respectively. Both survival rates were higher in LRD (p < 0.008 and p < 0.001). A pediatric renal transplant study has started, making information available to be shared between the centers and the world.