Christine S Hwang1,2, Jyothsna Gattineni3, Malcolm MacConmara4,5. 1. Division of Surgical Transplantation, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA. Christine.Hwang@utsouthwestern.edu. 2. Division of Pediatric Transplantation, Children's Medical Center, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., 4th Floor, Dallas, TX, 75390-856, USA. Christine.Hwang@utsouthwestern.edu. 3. Division of Nephrology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA. 4. Division of Surgical Transplantation, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA. 5. Division of Pediatric Transplantation, Children's Medical Center, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., 4th Floor, Dallas, TX, 75390-856, USA.
Abstract
BACKGROUND: Strategies to expand numbers of deceased donor kidneys suitable for pediatric recipients are urgently needed to prevent long-term dialysis-associated morbidity and mortality. Donors designated as increased risk of disease transmission (IRD) are infrequently used in pediatric recipients. We examined outcomes of these kidneys in pediatric patients and the potential to increase the donor pool. METHODS: The United Network for Organ Sharing (UNOS) database records presence of IRD in all deceased donors since 2004. All pediatric kidney transplant recipients from 2004 to 2017 were identified and stratified by IRD status, and outcomes were examined. RESULTS: Four hundred seventy-three pediatric kidney transplant recipients received an IRD allograft. IRD donors had lower kidney donor profile index (KDPI); were more likely to be younger, male, and Caucasian; and were more likely to have used drugs. IRD kidneys were more likely to have been biopsied and placed on pulsatile perfusion. Other than an older recipient age, demographic data were not different between groups. Allograft and patient survivals were similar, as were rejection and delayed graft function rates. Compared with adult recipients and adult IRD recipients, pediatric recipients were more likely to have a younger donor, receive a kidney with a lower creatinine, and were less likely to have delayed graft function (p < 0.05). There were no recorded disease transmissions in IRD group. CONCLUSIONS: Patient and allograft survivals are similar in IRD and non-IRD kidneys. High-quality IRD organs used in adults represent a large number of donors with excellent outcomes. IRD allografts have a potential to increase transplant volume and should be considered for pediatric patients.
BACKGROUND: Strategies to expand numbers of deceased donor kidneys suitable for pediatric recipients are urgently needed to prevent long-term dialysis-associated morbidity and mortality. Donors designated as increased risk of disease transmission (IRD) are infrequently used in pediatric recipients. We examined outcomes of these kidneys in pediatric patients and the potential to increase the donor pool. METHODS: The United Network for Organ Sharing (UNOS) database records presence of IRD in all deceased donors since 2004. All pediatric kidney transplant recipients from 2004 to 2017 were identified and stratified by IRD status, and outcomes were examined. RESULTS: Four hundred seventy-three pediatric kidney transplant recipients received an IRD allograft. IRD donors had lower kidney donor profile index (KDPI); were more likely to be younger, male, and Caucasian; and were more likely to have used drugs. IRD kidneys were more likely to have been biopsied and placed on pulsatile perfusion. Other than an older recipient age, demographic data were not different between groups. Allograft and patient survivals were similar, as were rejection and delayed graft function rates. Compared with adult recipients and adult IRD recipients, pediatric recipients were more likely to have a younger donor, receive a kidney with a lower creatinine, and were less likely to have delayed graft function (p < 0.05). There were no recorded disease transmissions in IRD group. CONCLUSIONS:Patient and allograft survivals are similar in IRD and non-IRD kidneys. High-quality IRD organs used in adults represent a large number of donors with excellent outcomes. IRD allografts have a potential to increase transplant volume and should be considered for pediatric patients.
Authors: Sean M Wrenn; Peter W Callas; Trishul Kapoor; Alia F Aunchman; Adam N Paine; Jaime A Pineda; Carlos E Marroquin Journal: Pediatr Transplant Date: 2017-09-17
Authors: Ann C Gaffey; Stacey L Doll; Arwin M Thomasson; Chantel Venkataraman; Carol W Chen; Lee R Goldberg; Emily A Blumberg; Michael A Acker; Francis Stone; Pavan Atluri Journal: J Thorac Cardiovasc Surg Date: 2016-01-22 Impact factor: 5.209
Authors: Adam K Morrison; Charitha Gowda; Dmitry Tumin; Christina M Phelps; Don Hayes; Joseph Tobias; Robert J Gajarski; Deipanjan Nandi Journal: Pediatr Transplant Date: 2018-05-17