The relationship of donor source and age on short‐ and long‐term allograft survival in pediatric renal transplantation

Abstract

Limited pediatric data on allograft survival from advanced aged kidney donors exist. To determine the influence of donor source and age on allograft survival in pediatric renal transplant recipients, we analyzed the OPTN database. Allograft survival for 7291 pediatric renal transplants was evaluated. Up to five yr post-transplantation, graft survival was higher for LD vs. DD recipients. At seven yr, allograft survival was 71% in 18-54 yr-old LD recipients, 59.1% in >or=55 yr-old LD, and 45.1% in >or=50 yr-old DD recipients. An approximate 35% improvement in allograft survival in 18-54 yr-old LD recipients was observed. Multivariate results showed that recipients of LD 35-49 (aRR 0.66, 95% CI 0.55-0.80) and LD 50-54 (aRR 0.65, 95% CI 0.45-0.94) have a graft survival advantage over the ideal DD. In LD >or=55 yr, no improvement in graft survival was observed when compared with the 18-34 yr-old DD. In summary, we observed in a pediatric population, <55 yr-old LD kidneys afford improved long-term allograft survival when compared with DD kidney recipients. Increasing awareness of the long-term graft survival advantage for children receiving an LD kidney, even from older donors, should be a priority.

Association Between Age and Graft Failure Rates in Young Kidney Transplant Recipients

“…Younger donor age was associated with a significantly lower risk of graft loss: for every 10 years younger the donor, the graft failure rate was 12% lower. Consistent with previous reports (10,11), failure rates were 26% to 29% lower in living donor versus deceased donor grafts (PϽ0.0001). Focal segmental glomerulosclerosis was associated with significantly higher failure risk, and "unknown" renal disease with a significantly lower risk than congenital anomalies of the kidneys or urinary tract.…”

Pediatric renal transplantation: an overview and update

“…Also, below 55-year-old live donor kidneys offered survival advantage even over the ideal deceased donor grafts from the below 35-year-old population [15]. Thus, living donation, which confers superior outcomes for pediatric recipients and does not require time on the waitlist, should be recommended whenever possible.…”

Organ allocation in pediatric renal transplants: is there an optimal donor?

“…In an (16). In addition, other studies that have examined variables associated with allograft survival have identified LD source to be associated with a survival advantage (8,18). While donor source is not the only predictor of long-term graft survival, it clearly plays a critical role with LDs providing the most durable option in pediatric recipients.…”

“…The mean age of all patients when transplanted was 13.2 AE 5.2 yr (range [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19], and 48% were male. One recipient in the DD group received two DD transplants during the study period.…”

“…Additional research has assessed the outcomes of all donor sources in pediatric kidney recipients (8,(15)(16)(17). However, few studies have focused specifically on the impact of the donor source (18,19). Therefore, we designed the present study to analyze the effect of donor type on the outcomes of pediatric patients who underwent kidney transplantation.…”