Pediatric renal transplantation—A UNOS database analysis of donor–recipient size mismatch. (18th January 2023)

• Record Type: Journal Article
• Authors: Kostakis, Ioannis D.; Chandak, Pankaj; Assia‐Zamora, Sergio; Gogalniceanu, Petrut; Loukopoulos, Ioannis; Calder, Francis; Stojanovic, Jelena; Kessaris, Nicos
• Is Part Of: Pediatric transplantation. Volume 27:Number 3(2023)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2023-01-18
• Subjects: body surface area -- delayed graft function -- graft survival -- pediatric renal transplants -- primary non‐function -- size mismatch; Transplantation of organs, tissues, etc. in children -- Periodicals; 617.95408305
• DOI: 10.1111/petr.14470
• Languages: English
• ISSNs: 1397-3142

Abstract

Abstract: Background: We used the BSAi (Donor BSA/Recipient BSA) to assess whether transplanting a small or large kidney into a pediatric recipient relative to his/her size influences renal transplant outcomes. Methods: We included 14 322 single‐kidney transplants in pediatric recipients (0–17 years old) (01/2000–02/2020) from the United Network for Organ Sharing database. We divided cases into four BSAi groups (BSAi ≤ 1, 1 < BSAi ≤ 2, 2 < BSAi ≤ 3, BSAi > 3). Results: There were no differences concerning delayed graft function (DGF) or primary non‐function (PNF) rates, whether the grafts were from living or brain‐dead donors. In both transplants coming from living donors and brain‐dead donors, cases with BSAi > 3 and cases with 2 < BSAi ≤ 3 had similar graft survival ( p = .13 for transplants from living donors, p = .413 for transplants from brain‐dead donors), and both groups had longer graft survival than cases with 1 < BSAi ≤ 2 and cases with BSAi ≤ 1 ( p < .001). The difference in 10‐year graft survival rates between cases with BSAi > 3 and cases with BSAi ≤ 1 reached around 25% in both donor types. The better graft survival in transplants with BSAi > 2 was confirmed in multivariable analysis. Conclusions: There is no significant impact of donor‐recipient size mismatch on DGF and PNF rates in pediatric renal transplants. However, graft survival is significantly improved when the donor's size is more than twice the pediatric recipient's size.