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Living unrelated renal transplantation: a good match for the pediatric candidate?

Kyle J Van Arendonk1, Babak J Orandi, Nathan T James

  • 1Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA. kvanare1@jhmi.edu

Journal of Pediatric Surgery
|July 13, 2013
PubMed

Insights

Living unrelated donor kidney transplants offer superior graft survival compared to deceased donor transplants in children. Survival is equivalent to living related donor transplants when accounting for factors like HLA mismatch.

Area of Science:

  • Pediatric Nephrology
  • Transplantation Immunology
  • Organ Donation

Background:

  • Living donor kidney transplantation is preferred for pediatric end-stage renal disease due to superior graft survival.
  • Pediatric candidates often receive priority for kidneys from younger deceased donors.

Purpose of the Study:

  • To compare the outcomes of pediatric kidney-only transplants from living related donors (LRRT), living unrelated donors (LURT), and deceased donors (DDRT).
  • To evaluate the impact of donor type on death-censored graft survival in pediatric kidney transplant recipients.

Main Methods:

  • Analysis of U.S. pediatric kidney-only transplants (1987-2012).
  • Comparison of graft survival across LRRT (n=7741), LURT (n=618), and DDRT (n=8945).
  • Utilized Kaplan-Meier analysis, multivariable Cox models, and matched controls.

Main Results:

  • Living unrelated donor renal transplants (LURT) showed superior unadjusted graft survival compared to deceased donor renal transplants (DDRT), even when compared to younger deceased donors.
  • While HLA mismatch was higher in LURT vs. LRRT, adjusted analyses (Cox model, matched controls) revealed equivalent graft survival between LURT and LRRT.
  • Adjusted hazard ratios indicated no significant difference in graft survival between LURT and LRRT (aHR=1.04, HR=1.02).

Conclusions:

  • Graft survival for pediatric living unrelated donor kidney transplants is superior to deceased donor transplants.
  • When adjusted for factors like HLA mismatch, living unrelated donor kidney transplant survival is equivalent to living related donor kidney transplant survival.
Abstract

Keywords:
Donor typeGraft survivalPediatric kidney transplantation

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