Matthew P Sypek1,2,3,4, Christopher E Davies4,5, Amelia K Le Page6, Philip Clayton4,5,7, Peter D Hughes1,2, Nicholas Larkins8, Germaine Wong9,10, Joshua Y Kausman1,3, Fiona Mackie11,12. 1. Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Melbourne, Vic, Australia. 2. Department of Nephrology, Royal Melbourne Hospital, Melbourne, Vic, Australia. 3. Department of Nephrology, Royal Children's Hospital, Melbourne, Vic, Australia. 4. Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, South Australian Health and Medical Research Institute, Adelaide, SA, Australia. 5. Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia. 6. Department of Nephrology, Monash Children's Hospital, Clayton, Vic, Australia. 7. Central and Northern Adelaide Transplant Service, Royal Adelaide Hospital, Adelaide, SA, Australia. 8. Faculty of Health and Medical Sciences, Paediatrics, The University of Western Australia, Perth, WA, Australia. 9. School of Public Health, The University of Sydney, Sydney, NSW, Australia. 10. Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia. 11. Department of Nephrology, Sydney Children's Hospital, Randwick, NSW, Australia. 12. School of Women's and Child Health, U.N.S.W., Sydney, NSW, Australia.
Abstract
BACKGROUND: In this 30-year national review, we describe trends in DD transplantation for paediatric recipients, assess the impact of paediatric allocation bonuses and identify outstanding areas of need for this population. METHODS: A retrospective review of all DD kidney only transplants to paediatric recipients (<18 years old) in Australia between 1989 and 2018 was conducted using deidentified extracts from the ANZDATA. RESULTS: Of the 1011 kidney only transplants performed in paediatric recipients during the study period, 426 (42%) were from deceased donors. Paediatric candidates on the DD waiting list had consistently higher rates of transplantation and shorter time from dialysis initiation to transplantation compared with adult candidates (median 372 vs 832 days in 2018, for example). Donor characteristics remained more favourable for paediatric recipients, despite a decline in the overall quality of the donor pool. The mean number of HLA antigen mismatches for paediatric recipients of DD transplants increased each decade (2.86 [1989-1998], 3.85 [1999-2008], 4.01 [2009-2018]). Both patient and graft survival have improved for paediatric DD transplant recipients in the most recent era (5-year graft and patient survival 85% vs 65% and 99% vs 94%, respectively, for 2009-2018 vs 1999-2008). CONCLUSIONS: The current DD kidney allocation system in Australia provides rapid access to high-quality organs for paediatric recipients, and early graft loss has decreased significantly in recent years; however, additional targeted interventions to address HLA matching may improve long-term outcomes in this population.
BACKGROUND: In this 30-year national review, we describe trends in DD transplantation for paediatric recipients, assess the impact of paediatric allocation bonuses and identify outstanding areas of need for this population. METHODS: A retrospective review of all DD kidney only transplants to paediatric recipients (<18 years old) in Australia between 1989 and 2018 was conducted using deidentified extracts from the ANZDATA. RESULTS: Of the 1011 kidney only transplants performed in paediatric recipients during the study period, 426 (42%) were from deceased donors. Paediatric candidates on the DD waiting list had consistently higher rates of transplantation and shorter time from dialysis initiation to transplantation compared with adult candidates (median 372 vs 832 days in 2018, for example). Donor characteristics remained more favourable for paediatric recipients, despite a decline in the overall quality of the donor pool. The mean number of HLA antigen mismatches for paediatric recipients of DD transplants increased each decade (2.86 [1989-1998], 3.85 [1999-2008], 4.01 [2009-2018]). Both patient and graft survival have improved for paediatric DD transplant recipients in the most recent era (5-year graft and patient survival 85% vs 65% and 99% vs 94%, respectively, for 2009-2018 vs 1999-2008). CONCLUSIONS: The current DD kidney allocation system in Australia provides rapid access to high-quality organs for paediatric recipients, and early graft loss has decreased significantly in recent years; however, additional targeted interventions to address HLA matching may improve long-term outcomes in this population.