Organ allocation in pediatric renal transplants: is there an optimal donor?. (13th November 2013)

• Record Type: Journal Article
• Authors: Pitt, Susan C.; Vachharajani, Neeta; Doyle, Maria B.; Lowell, Jeffrey A.; Chapman, William C.; Anderson, Christopher D.; Shenoy, Surendra; Wellen, Jason R.
• Is Part Of: Clinical transplantation. Volume 27:Number 6(2013:Nov./Dec.)
• Page Start: 938
• Page End: 944
• Publication Date: 2013-11-13
• Subjects: Transplantation of organs, tissues, etc -- Periodicals; 617.95
• DOI: 10.1111/ctr.12272
• Languages: English
• ISSNs: 0902-0063

Abstract

<abstract abstract-type="main" id="ctr12272-abs-0001"> <title>Abstract</title> <p>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.</p> </abstract>