Grandparent donors in paediatric renal transplantation

Abstract

The outcome of transplantation from grandparent donors in comparison with parental donors in paediatric renal transplantation was evaluated in 53 living related donor (LRD) transplantations performed between January 1996 and August 2003. The donor in 13 cases (25%) was a grandparent (Gpar group), and the remaining donors formed the parent group (Par group). The median age of recipients in the Gpar group was 2.75 (1.7-10.6) years and in the Par group was 12.75 (2.4-22) years (P<0.0001). There was no evidence of a difference in patient and graft survival, glomerular filtration rate (GFR) after transplantation, or the number of biopsy proven episodes of rejection between the groups. Doses of prednisolone in the first year following transplantation were greater in recipients from Gpar donors, but the other immunosuppression doses were similar. The median age of donors in the Gpar group was 56 (50-67) years and in the Par group was 41 (27-58) years (P<0.0001). There was no evidence of a difference between the two donor groups in mean creatinine clearance at last follow-up. There were two major donor complications in the Gpar group and one in the Par group. There was no evidence that the length of stay differed between the two groups in either the donors or recipients. These results support the use of carefully selected healthy grandparents as LRDs in children. This option potentially allows for the use of parent donors for a subsequent transplantation.

The impact of donor/recipient age difference and HLA mismatch on graft outcome in pediatric kidney transplantation

“…A number of adult studies have reported that increasing age of the donor is associated with worse graft survival in both DD and LD recipients . In contrast, some adult and pediatric studies have reported good long‐term graft outcomes irrespective of donor age, including in recipients of kidneys from older donors . There was no significant association between the donor age and graft outcomes in our study either for the whole cohort or separately for LD and DD transplants recipients.…”

“…[13][14][15] In contrast, some adult and pediatric studies 7,16,17 have reported good long-term graft outcomes irrespective of donor age, including in recipients of kidneys from older donors. [18][19][20] There was no significant association between the donor age and graft outcomes in our study either for the whole cohort or separately for LD and DD transplants recipients. In one study, 7 transplant outcomes in pediatric patients were only worse from LDs of 55 years or older which could explain our findings given the small number of donors of this age group in our cohort.…”

Australian deceased donor kidney allocation protocols: Transplant waiting and graft quality for children and adolescents

“…This concept of early planning to extend re-transplant options may also have been a factor at play in Victoria where a higher proportion of LD came from grandparents. A previous analysis of graft outcome after LD kidney transplantation in Victoria found no difference in graft survival for LD transplants from grandparent versus other LD (11). Other papers show little overall effect of donor age on LD graft outcomes (12).…”

“…A disadvantage, however, is reported for the use of older DD kidneys on graft survival, which is significant between the reference donor age of 15–24 yr and donors aged 45 yr and older . This disadvantage may be further exaggerated with increased HLA mismatches . Reduced time on dialysis may offset some of this disadvantage , but teasing out the relative importance of these factors requires further study.…”

Five decades with grandparent donors: The Norwegian strategy and experience

“…Long‐term outcome data for grandparents as donors for children with ESRD are scarce, with only a few publications 4‐6 . The observation time varies from two to 20 years and shows satisfactory GS.…”