BACKGROUND/ PURPOSE: Living donor kidney transplantation is encouraged for children with end-stage renal disease given the superior survival of living donor grafts, but pediatric candidates are also given preference for kidneys from younger deceased donors. METHODS: Death-censored graft survival of pediatric kidney-only transplants performed in the U.S. between 1987-2012 was compared across living related (LRRT) (n=7741), living unrelated (LURT) (n=618), and deceased donor renal transplants (DDRT) (n=8945) using Kaplan-Meier analysis, multivariable Cox proportional hazards models, and matched controls analysis. RESULTS: As expected, HLA mismatch was greater among LURT compared to LRRT (p<0.001). Unadjusted graft survival was lower, particularly long-term, for LURT compared to LRRT (p=0.009). However, LURT graft survival was still superior to DDRT graft survival, even when compared only to deceased donors under age 35 (p=0.002). The difference in graft survival between LURT and LRRT was not seen when adjusting for HLA mismatch, year of transplantation, and donor and recipient characteristics using a Cox model (aHR=1.04, 95% CI: 0.87-1.24, p=0.7) or matched controls (HR=1.02, 95% CI: 0.82-1.27, p=0.9). CONCLUSION: Survival of LURT grafts is superior to grafts from younger deceased donors and equivalent to LRRT grafts when adjusting for other factors, most notably differences in HLA mismatch.
BACKGROUND/ PURPOSE: Living donor kidney transplantation is encouraged for children with end-stage renal disease given the superior survival of living donor grafts, but pediatric candidates are also given preference for kidneys from younger deceased donors. METHODS: Death-censored graft survival of pediatric kidney-only transplants performed in the U.S. between 1987-2012 was compared across living related (LRRT) (n=7741), living unrelated (LURT) (n=618), and deceased donor renal transplants (DDRT) (n=8945) using Kaplan-Meier analysis, multivariable Cox proportional hazards models, and matched controls analysis. RESULTS: As expected, HLA mismatch was greater among LURT compared to LRRT (p<0.001). Unadjusted graft survival was lower, particularly long-term, for LURT compared to LRRT (p=0.009). However, LURT graft survival was still superior to DDRT graft survival, even when compared only to deceased donors under age 35 (p=0.002). The difference in graft survival between LURT and LRRT was not seen when adjusting for HLA mismatch, year of transplantation, and donor and recipient characteristics using a Cox model (aHR=1.04, 95% CI: 0.87-1.24, p=0.7) or matched controls (HR=1.02, 95% CI: 0.82-1.27, p=0.9). CONCLUSION: Survival of LURT grafts is superior to grafts from younger deceased donors and equivalent to LRRT grafts when adjusting for other factors, most notably differences in HLA mismatch.
Authors: A B Massie; J Leanza; L M Fahmy; E K H Chow; N M Desai; X Luo; E A King; M G Bowring; D L Segev Journal: Am J Transplant Date: 2016-02-26 Impact factor: 8.086
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Authors: Heather L Wasik; Cozumel S Pruette; Rebecca L Ruebner; Mara A McAdams-DeMarco; Sheng Zhou; Alicia M Neu; Dorry L Segev; Allan B Massie Journal: Am J Transplant Date: 2019-04-09 Impact factor: 8.086
Authors: Abimereki D Muzaale; Allan B Massie; Mei-Cheng Wang; Robert A Montgomery; Maureen A McBride; Jennifer L Wainright; Dorry L Segev Journal: JAMA Date: 2014-02-12 Impact factor: 56.272
Authors: Abimereki D Muzaale; Allan B Massie; Lauren M Kucirka; Xun Luo; Komal Kumar; Ryan S Brown; Saad Anjum; Robert A Montgomery; Krista L Lentine; Dorry L Segev Journal: Transplantation Date: 2016-06 Impact factor: 4.939
Authors: Loes Oomen; Charlotte Bootsma-Robroeks; Elisabeth Cornelissen; Liesbeth de Wall; Wout Feitz Journal: Front Pediatr Date: 2022-04-08 Impact factor: 3.569