Increased risk organ transplantation in the pediatric population

Area of Science:

• Transplantation immunology
• Infectious disease in transplantation
• Pediatric surgery

Background:

• Organs from donors with infectious disease risk (IRD) are underutilized, especially in pediatric transplant recipients, due to perceived risks of viral transmission (HIV, Hepatitis B/C).
• This underutilization contributes to longer wait times and associated morbidity/mortality for pediatric patients awaiting organ transplantation.

Purpose of the Study:

• To evaluate the outcomes of pediatric kidney and liver transplants utilizing organs from donors with infectious disease risk (IRD) compared to standard risk (SRD) donors.
• To analyze organ acceptance rates, waitlist times, and infectious transmissions associated with IRD organ utilization in pediatric recipients.

Main Methods:

• Retrospective analysis of the United Network for Organ Sharing (UNOS) database for pediatric renal and hepatic transplants (2004-2008).
• Comparison of patient and graft survival between IRD and SRD organs using proportional hazards regression.
• Analysis of organ acceptance rates, waitlist duration, and reported infectious transmissions.

Main Results:

• No statistically significant differences in patient or graft survival were observed between IRD and SRD kidney or liver transplants.
• Organ acceptance rates for IRD kidneys (1.5%) and livers (1.99%) were lower than for SRD organs (4.82% and 4.51%, respectively).
• A single bloodborne pathogen transmission was reported across 7797 unique transplants from 2008-2015, indicating a low transmission risk.

Conclusions:

• Pediatric kidney and liver transplants using IRD organs demonstrate comparable survival outcomes to those using SRD organs.
• Increasing the utilization of IRD organs could significantly improve access to transplantation for pediatric patients.
• Wider acceptance of IRD organs may reduce transplant wait times and mitigate risks associated with prolonged waitlist periods.