Comparable Survival of En Bloc versus Standard Donor Kidney Transplants in Children

Winnicki, Erica; Dharmar, Madan; Tancredi, Daniel J.; Butani, Lavjay

doi:10.1016/j.jpeds.2016.01.054

Cited by 25 publications

(28 citation statements)

References 28 publications

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“…This national study of pediatric kidney transplantation from very small pediatric donors weighing 10-20 kg shows that the majority of these kidneys were transplanted into adult recipients and, over time, were Studies in support of utilizing small and/or very small pediatric donor kidneys for children are largely single-center, low sample size analyses, 19,20,22 except for one registry study. 23 Filler et al 19 25 Our study also suggests that with increasing recipient body mass, graft survival of small pediatric EB grafts approaches that of adult donors.…”

Section: Discussionsupporting

confidence: 54%

“…Amante and Kahan reported successful short‐term graft survival with EB transplantation of kidneys from donors ≤6 years of age into 2 older children (age 12) . In a much larger study of 6882 recipients, Winnicki and others reported similar overall graft survival of pediatric recipients receiving EB kidneys from donors 1‐3 years of age (HR, 1.15; 95% CI, 0.83‐1.59) compared to standard adult deceased‐donor transplants in the OPTN registry …”

Section: Discussionmentioning

confidence: 95%

“…Studies in support of utilizing small and/or very small pediatric donor kidneys for children are largely single‐center, low sample size analyses, except for one registry study . Filler et al .…”

Section: Discussionmentioning

confidence: 99%

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Very small pediatric donor kidney transplantation in pediatric recipients

Yaffe

Friedmann

Kayler

2017

Pediatric Transplantation

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Kidneys from very small pediatric donors (age <5 years, weight <21 kg) may be a means to increase the donor pool for pediatric recipients. Transplantation of small pediatric kidneys is more commonly performed in adult recipients due to the increased risks of technical complications, thrombosis, and early graft failure. While these risks are abrogated in adult recipients by limiting the donor weight to ≥10 kg and using the EB technique, it is unknown whether pediatric recipients achieve comparable results. US national data were assessed for all first-time, deceased-donor, kidney-only pediatric recipients, 1/1996-10/2013, who received very small pediatric donor grafts or grafts from ideal adult donors. We identified 57 pediatric EB, 110 pediatric SK, and 2350 adult transplants. The primary outcome was 3-year all-cause graft survival. Kaplan-Meier curves showed worse outcomes for pediatric grafts compared to adult ideal grafts (P=.042). On multivariate analysis, pediatric recipients of SK grafts had significantly higher HRs (aHR 2.01, 95% CI 1.34-3.00) and pediatric recipients of EB grafts had somewhat higher non-significant HRs (1.57; 95% CI 0.88-2.79) for graft survival. These results suggest cautionary use of very small pediatric donors as a source to expand the donor pool for pediatric candidates.

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Section: Discussionsupporting

confidence: 54%

Section: Discussionmentioning

confidence: 95%

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Very small pediatric donor kidney transplantation in pediatric recipients

Yaffe

Friedmann

Kayler

2017

Pediatric Transplantation

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“…We limited our analysis to first-time transplants as patients undergoing re-transplantation might carry other risk factors for graft failure such as sensitization, recurrent disease, comorbidities or questionable compliance. Given the unique anatomic challenges associated with the transplantation of very small and en bloc pediatric kidneys as well as the lack of uniformity in the decision to split such kidneys(6, 7), we chose to limit our analyses to single kidneys from donors age 3–17 (en blocs removed). For survival analyses, the study population was limited to those transplanted between January 1, 2000 and December 31, 2009, allowing for a minimum of 6.25 years follow-up to March 31, 2016.…”

Section: Methodsmentioning

confidence: 99%

The kidney allocation system does not appropriately stratify risk of pediatric donor kidneys: Implications for pediatric recipients

Nazarian

Peng

Duggirala

et al. 2018

American Journal of Transplantation

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Kidney Allocation System (KAS) was enacted in 2014 to improve graft utility, while facilitating transplantation of highly-sensitized patients and preserving pediatric access to high-quality kidneys. Central to this system is the Kidney Donor Profile Index (KDPI), a metric intended to predict transplant outcomes based on donor characteristics but derived using only adult donors. We posited that KAS had inadvertently altered the profile and quantity of kidneys made available to pediatric recipients. This question arose from our observation that most pediatric donors carry a KDPI over 35 and have therefore been rendered relatively inaccessible to pediatric recipients under KAS. Here we explore early trends in pediatric transplantation following KAS, including: (i) use of pediatric donors, (ii) use of Public Health System (PHS) high infectious risk donors, (iii) wait time, and (iv) living donor transplantation. We note some concerning preliminary changes following KAS implementation, including the allocation of fewer deceased donor pediatric kidneys to children and stagnation in pediatric wait times. Moreover, the poor predictive power of the KDPI for adult donors appears to be even worse when applied to pediatric donors. These early trends warrant further observation and consideration of changes in pediatric kidney allocation if they persist.

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“…These studies, while promising, have been limited to small case reports and series. Very recently, our group undertook an analysis of the outcomes of en bloc renal transplants in pediatric recipients, using the large national Organ Procurement and Transplantation Network database [9]. The study analyzed information on 126 children who received an en bloc transplant; outcomes on these were compared to 6756 children who received a standard deceased donor transplant.…”

Section: En Bloc Renal Transplantation: Show Me the Money!mentioning

confidence: 99%