Organ allocation in pediatric renal transplants: is there an optimal donor?

Abstract

The 2005 revised allocation scheme for pediatric renal transplantation made the decision of whether to transplant an available living-donor (LD) kidney or use a deceased-donor (DD) kidney controversial. The aim of this study was to examine kidney allograft utilization, sensitization, and outcomes of pediatric transplant recipients. Between January 2000 and December 2009, 91 consecutive pediatric kidney recipients (<20 yr) were transplanted. The LD (n = 38) and DD (n = 53) groups were similar in age, gender, dialysis status at transplant, warm ischemia time, and overall patient survival. LD recipients were more likely to be Caucasian (92 vs. 69%), receive older allografts (39 ± 10 vs. 23 ± 9 yr), and have fewer human leukocyte antigen (HLA) mismatches (3.3 ± 1.6 vs. 4.4 ± 1.5, p < 0.01 for all). Graft survival at one, three, and five yr post-transplant was longer for LD recipients (97%, 91%, 87% vs. DD 89%, 79%, 58%, respectively, p < 0.05). At the time of transplant, 17 (33%) DD recipients had an available LD (mean age 40 yr). A greater proportion of all patients were moderately (PRA 21-79%) sensitized post-transplant (p < 0.05). A multivariable analysis of graft survival indicated that the advantage in LD organs was likely due to fewer HLA mismatched in this group. Nonetheless, LD organs appear to provide optimal outcomes in pediatric renal transplants when considering the risk of becoming sensitized post-transplant complicating later use of the LD kidney.

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

“…If available, a LD is generally considered the best donor option with multiple studies demonstrating increased graft and recipient survival and better quality of life when compared to DD transplantation . As LDs are often biologically related to the pediatric recipient, HLA matching likely plays an important role in this outcome.…”

“…If available, a LD is generally considered the best donor option with multiple studies demonstrating increased graft and recipient survival and better quality of life when compared to DD transplantation. [7][8][9][10] As LDs are often biologically related to the pediatric recipient, HLA matching likely plays an important role in this outcome. However, whether this survival benefit is preserved with increasing age difference between the donor and the recipient in LD transplants is unknown.…”

Pre-Emptive Pediatric Kidney Transplantation or Not?

“…Occurrence of graft loss in the NPKT group was 12 months faster than that seen in the PKT group. The population studied here presented no difference in graft survival according to donor type; however, Pitt et al [3] found a superior graft survival in a living donor group. In the past 10 years, graft and patient survival rates have been compared between recipients of PKT and those of NPKT in different studies, and the outcomes have been shown to be comparable or even better for PKT [4e7].…”

Trajectories and Predictors of Allograft Dysfunction after Renal Transplantation in Children

“…Other reports have already found statistically significant longer graft survivals in pediatric recipients of grafts from living versus deceased donors [20][21][22] . On the other hand, in a model of GFR prognosis after pediatric kidney transplantation, Pape et al [23] found that donation from living donors did not correspondingly improve the prediction of GFR.…”