Kidney transplant outcomes associated with the use of increased risk donors in children
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Updated: Jan 31, 2026
Robot-Assisted Kidney Transplantation
Published on: July 19, 2021
Sarah J Kizilbash1, Michelle N Rheault1, Qi Wang2
1Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota.
Insights
Kidney transplants from increased risk donors (IRD) offer higher patient survival for children compared to remaining on the waitlist. However, outcomes were similar to non-IRD transplants, suggesting IRDs can be safely considered for pediatric kidney recipients.
Area of Science:
- Nephrology
- Transplantation
- Public Health
Background:
- Increased risk donors (IRDs) pose a risk of transmitting blood-borne viruses.
- The use and outcomes of IRD kidney transplants in pediatric populations are not well-established.
Purpose of the Study:
- To determine the rates and outcomes of pediatric deceased donor kidney transplants utilizing IRDs in the United States.
- To compare patient and graft survival between pediatric recipients of IRD and non-IRD kidney transplants.
Main Methods:
- Utilized the Scientific Registry of Transplant Recipients (SRTR) database.
- Analyzed pediatric deceased donor kidney transplants from January 1, 2005, to December 31, 2015.
- Employed Cox regression analysis to compare survival outcomes and assess the benefit of IRD transplants versus remaining on the waitlist.
Main Results:
- 328 recipients received IRD kidney transplants, while 4850 received non-IRD transplants.
- IRD recipients had higher mean calculated panel reactive antibody (cPRA).
- Patient survival was significantly higher after IRD transplants compared to remaining on the waitlist (aHR: 0.48).
- Patient and graft survival were similar between IRD and non-IRD recipients after multivariate adjustment.
Conclusions:
- Kidney transplantation from IRDs should be considered for children awaiting transplants.
- IRD kidney transplants provide a survival benefit for pediatric patients compared to remaining on the waitlist.
- Long-term graft and patient survival are comparable between IRD and non-IRD kidney transplants in children.
Abstract:
Increased risk donors (IRDs) may inadvertently transmit blood-borne viruses to organ recipients through transplant. Rates of IRD kidney transplants in children and the associated outcomes are unknown. We used the Scientific Registry of Transplant Recipients to identify pediatric deceased donor kidney transplants that were performed in the United States between January 1, 2005 and December 31, 2015. We used the Cox regression analysis to compare patient and graft survival between IRD and non-IRD recipients, and a sequential Cox approach to evaluate survival benefit after IRD transplants compared with remaining on the waitlist and never accepting an IRD kidney. We studied 328 recipients with and 4850 without IRD transplants. The annual IRD transplant rates ranged from 3.4% to 13.2%. IRDs were more likely to be male (P = .04), black (P < .001), and die from head trauma (P = .006). IRD recipients had higher mean cPRA (0.085 vs 0.065, P = .02). After multivariate adjustment, patient survival after IRD transplants was significantly higher compared with remaining on the waitlist (adjusted hazard ratio [aHR]: 0.48, 95% CI: 0.26-0.88, P = .018); however, patient (aHR: 0.93, 95% CI: 0.54-1.59, P = .79) and graft survival (aHR: 0.89, 95% CI: 0.70-1.13, P = .32) were similar between IRD and non-IRD recipients. We recommend that IRDs be considered for transplant in children.
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