Nicholas C Chesnaye1, Karlijn J van Stralen2, Marjolein Bonthuis1, Jaap W Groothoff3, Jérôme Harambat4, Franz Schaefer5, Nur Canpolat6, Arnaud Garnier7, James Heaf8, Huib de Jong9, Søren Schwartz Sørensen10, Burkhard Tönshoff11, Kitty J Jager1. 1. Department of Medical Informatics, ESPN/ERA-EDTA Registry and ERA-EDTA Registry, Amsterdam, The Netherlands. 2. Spaarne Gasthuis Academie, Spaarne Gasthuis, Hoofddorp, The Netherlands. 3. Department of Pediatric Nephrology, Emma Children's Hospital AMC, Amsterdam, The Netherlands. 4. Department of Pediatrics, Bordeaux University Hospital, Bordeaux, France. 5. Division of Paediatric Nephrology, University of Heidelberg, Center for Pediatrics and Adolescent Medicine, Heidelberg, Germany. 6. Department of Pediatrics, Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Turkey. 7. Pediatric Nephrology Unit, Toulouse University Hospital, Toulouse, France. 8. Department of Medicine, Zealand University Hospital, Roskilde, Denmark. 9. Erasmus Medical Center, Rotterdam, The Netherlands. 10. Department of Nephrology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark. 11. Department of Pediatrics I, University Children's Hospital, Heidelberg, Germany.
Abstract
BACKGROUND: The impact of donor age in paediatric kidney transplantation is unclear. We therefore examined the association of donor-recipient age combinations with graft survival in children. METHODS: Data for 4686 first kidney transplantations performed in 13 countries in 1990-2013 were extracted from the ESPN/ERA-EDTA Registry. The effect of donor and recipient age combinations on 5-year graft-failure risk, stratified by donor source, was estimated using Kaplan-Meier survival curves and Cox regression, while adjusting for sex, primary renal diseases with a high risk of recurrence, pre-emptive transplantation, year of transplantation and country. RESULTS: The risk of graft failure in older living donors (50-75 years old) was similar to that of younger living donors {adjusted hazard ratio [aHR] 0.74 [95% confidence interval (CI) 0.38-1.47]}. Deceased donor (DD) age was non-linearly associated with graft survival, with the highest risk of graft failure found in the youngest donor age group [0-5 years; compared with donor ages 12-19 years; aHR 1.69 (95% CI 1.26-2.26)], especially among the youngest recipients (0-11 years). DD age had little effect on graft failure in recipients' ages 12-19 years. CONCLUSIONS: Our results suggest that donations from older living donors provide excellent graft outcomes in all paediatric recipients. For young recipients, the allocation of DDs over the age of 5 years should be prioritized.
BACKGROUND: The impact of donor age in paediatric kidney transplantation is unclear. We therefore examined the association of donor-recipient age combinations with graft survival in children. METHODS: Data for 4686 first kidney transplantations performed in 13 countries in 1990-2013 were extracted from the ESPN/ERA-EDTA Registry. The effect of donor and recipient age combinations on 5-year graft-failure risk, stratified by donor source, was estimated using Kaplan-Meier survival curves and Cox regression, while adjusting for sex, primary renal diseases with a high risk of recurrence, pre-emptive transplantation, year of transplantation and country. RESULTS: The risk of graft failure in older living donors (50-75 years old) was similar to that of younger living donors {adjusted hazard ratio [aHR] 0.74 [95% confidence interval (CI) 0.38-1.47]}. Deceased donor (DD) age was non-linearly associated with graft survival, with the highest risk of graft failure found in the youngest donor age group [0-5 years; compared with donor ages 12-19 years; aHR 1.69 (95% CI 1.26-2.26)], especially among the youngest recipients (0-11 years). DD age had little effect on graft failure in recipients' ages 12-19 years. CONCLUSIONS: Our results suggest that donations from older living donors provide excellent graft outcomes in all paediatric recipients. For young recipients, the allocation of DDs over the age of 5 years should be prioritized.
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