Late Graft Loss among Pediatric Recipients of DCD Kidneys

Abstract

SummaryBackground and objectives Kidney transplantation from donors after cardiac death (DCD) provides similar graft survival to donors after brain death (DBD) in adult recipients. However, outcomes of DCD kidneys in pediatric recipients remain unclear, primarily because of limited sample sizes.Design, setting, participants, & measurements We identified 137 pediatric (Ͻ18 years old) recipients of DCD kidneys between 1994 and 2010 using Scientific Registry of Transplant Recipients data and compared outcomes with 6059 pediatric recipients of DBD kidneys during the same time period, accounting for donor, recipient, and transplant characteristics using time-varying Cox regression and matched controls. Long-term follow-up (4 years or beyond) was available for 31 DCD recipients.Results Pediatric recipients of DCD kidneys experienced a significantly higher rate of delayed graft function (22.0% versus 12.3%; P ϭ 0.001), although lower than reported delayed graft function rates of DCD grafts in adults. Although DCD and DBD graft survival was equal in the early postoperative period, graft loss among pediatric recipients of DCD kidneys exceeded their DBD counterparts starting 4 years after transplantation. This effect was statistically significant in a multivariate Cox model (hazard ratio ϭ 2.03; 95% confidence interval, 1.21 to 3.39; P ϭ 0.007) and matched-controls analysis (hazard ratio ϭ 2.36; 95% confidence interval, 1.11 to 5.03; P ϭ 0.03).Conclusions A significant increase in DCD graft loss starting 4 years after transplantation motivates a cautious approach to the use of DCD kidneys in children, in whom long-term graft survival is of utmost importance.

Reduced ATG‐F dosage for induction in pediatric renal transplantation: A single‐center experience

“…A retrospective analysis of 4026 such recipients found that only 26 received organs from cardiac death donors, with these recipients showing no significant differences in one‐ and five‐yr survival rates compared with recipients from brain death donors . In contrast, another study comparing 137 recipients of cardiac death and 6059 of brain death donors found that the incidence of delayed graft function was significantly higher (22.0% vs. 12.3%, p = 0.001) and the four‐yr survival rate significantly lower (p = 0.007) in the former group . In the present study, the incidence of delayed graft function was higher in recipients of cardiac death than living related donor kidneys, but there were no significant differences in incidence of acute rejection and survival rates of patients and kidneys, indicating that brain and cardiac death donors can provide reliable kidneys for pediatric renal transplantation.…”

Recommendations for donation after circulatory death kidney transplantation in Europe

“…A meta‐analysis in 2005 shows that DCD kidney transplantation carries a 3.6 fold increase in the risk of DGF compared with DBD kidneys, which is confirmed by more recent comparative studies . There have been no specific recipients characteristics identified that are associated with DGF in DCD transplantation although there was a trend for more DGF in male recipients and patients with prolonged dialysis .…”

“…Death censored graft survival of DCD kidneys depends on the selection of DCD kidneys and is in most studies slightly higher to equivalent to DBD kidneys. Particularly in children and in re‐transplantation, DCD kidneys were at higher risk for graft failure .…”

Pediatric Organ Donation and Transplantation

“…41 More widespread acceptance of DCDD kidneys for transplantation into children will require greater assessment of long-term function, which should be optimized for younger recipients. 42 Both examples underscore how adult donors are mitigating organ shortage for children. At first glance, the allocation of DCDD organs seems to highlight how pediatric donation helps alleviate the organ shortage in the adult population.…”