Non‐standard criteria donors in pediatric kidney transplantation

Abstract

KT remains the treatment of choice for ESRD in children. However, the demand for kidney transplants continues to outstrip supply, even in the pediatric scenario. We reviewed the applicability of nonSCDs for pediatric KT. There is a lack of studies analyzing this modality among pediatric donors and recipients, where most conclusions are based on predictions from adult data. Nevertheless, marginal donors might be a reasonable option in selected cases. For example, the use of older LDs is an acceptable option, with outcomes comparable to SCDs. Organs donated after cardiac death represent another possibility, albeit with logistic, ethical, and legal limitations in some countries. AKI donors also constitute an option in special situations, although there are no pediatric data on these transplants. Likewise, there are no data on the use of expanded criteria donors in pediatric patients, but this appears not to be a good option, considering the compromised long‐term survival.

Strategies to Expand the Deceased Donor Pool for Pediatric Kidney Transplant Recipients

“…A retrospective study comparing 286 pediatric DCD recipients with 9651 pediatric non-DCD recipients, transplanted in the United States, found no difference in 10-year patient and graft survival between the groups (12). Similarly, a study of 1772 pediatric transplants using the United Kingdom transplant registry found no difference in 3-year patient and graft survival between DCD and non-DCD transplants (13). Although the pediatric data on DCD transplants are limited, the existing data are encouraging.…”

First pediatric organ donation after circulatory determination of death in Singapore: Facing challenges in the absence of a local practice guideline

“…Pediatric organ donation after circulatory determination of death (DCD) has been increasingly explored as an additional source to supply needed organs for transplantation 11‐14 . In Asia, pediatric DCD cases have been described in China 15,16 .…”