Longitudinal analysis of living donor kidney transplant rates in pediatric candidates in the United States

Abstract

Among adults, living donor kidney transplant rates began declining in the United States after 2004 but whether a similar decline is occurring in the pediatric candidates has not been well studied. Share 35, a change in allocation rules implemented in October of 2005, may also have influenced rates of living donation. We sought to determine whether a decline in rates was occurring in pediatric candidates and whether the Share 35 program was the cause of the decline. All children listed for a kidney transplant or transplanted with a living donor without listing between 1996 and 2011 were identified in the United States (N=14 911) of which 6046 had received a living donor transplant during follow-up. Kaplan-Meier analysis showed a decline in living donor rates in candidates listed after 2001. Logistic regression analysis for living donor kidney transplantation confirmed the timing of the drop but also showed that changes in candidate demographics and center listing practices were impacting rates. A large drop in parental donation was the main cause for the drop. The rate of living donor transplant among pediatric candidates declined after 2001 predating by 4 years the implementation of Share 35, suggesting that factors other than changes in allocation rules are responsible for the decline.

The choice between deceased‐ vs living‐donor renal transplantation in children: Analysis of data from a Belgian tertiary center

“…In a retrospective analysis by Abraham et al, a drop in the incidence of living kidney donation was attributed to the Share 35 policy . In contrast, a longitudinal analysis of the reasons for decline in living kidney donation in the United States revealed a drop in parental donation as the main factor of decreased LD KT rather than the amended allocation rules …”

Application and interpretation of histocompatibility data in pediatric kidney transplantation

“…Since 1999, living related donation in pediatric kidney transplant (KT) programs has decreased from 45% to 30%. 1 Pediatric KT recipient outcomes are linked to age at transplant, degree of alloimmune sensitization, and living versus deceased kidney donors. 2, 3 Central to these factors are the immunological risk of the donated organ to the recipient.…”

Decreasing living donor rates in pediatric kidney transplantation: A time for action

“…This decline persists despite the fact that living donor kidney transplantation is well established as the optimal treatment for children and also adults with end‐stage kidney disease due to superior graft and patient survival . As demonstrated by Keith et al . in this issue of Pediatric Transplantation, the trend for pediatrics likely began as early as 2001, even after adjustment for changing demographics and center listing practices.…”

“…While Share 35 increased the number of deceased donors for pediatric candidates, some worried that a decline in living donation, especially from parents, might have resulted from easier access to deceased donors for the first pediatric transplant and consideration of reserving living related donors for a subsequent transplant that is needed to sustain long life in pediatric recipients . In their analysis of SRTR data, Keith et al . clearly demonstrate that the decrease in living donation among pediatric kidney transplant recipients started in 2001, well before implementation of Share 35 in 2005.…”

“…Historically, parents have been the leading source of donors for pediatric recipients. Data from Keith et al point to the drop in living donation being driven strongly by a decrease in parental donation. How does your center data align with national trends? Examine your center's listing practices .…”