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Normothermic Ex Vivo Kidney Perfusion for the Preservation of Kidney Grafts prior to Transplantation
Published on: July 15, 2015
Delayed graft function in pediatric living donor kidney transplantation
Christine S Hwang1,2, Yash Kadakia3, Jorge A Sanchez-Vivaldi1,2
1Division of Surgical Transplantation, Department of Surgery, University Of Texas Southwestern Medical Center, Dallas, Texas, USA.
Insights
Delayed graft function (DGF) in pediatric living donor kidney transplants significantly impacts outcomes. Patients experiencing DGF had substantially lower 1-year allograft survival rates, highlighting the need for optimized donor-recipient matching.
Area of Science:
- Nephrology
- Transplantation Immunology
- Pediatric Surgery
Background:
- Pediatric living donor kidney transplantation is associated with a low incidence of delayed graft function (DGF).
- Understanding the specific risk factors and consequences of DGF in this population is crucial for improving patient outcomes.
- This study investigates DGF in pediatric recipients of living donor kidney allografts.
Purpose of the Study:
- To determine the incidence and identify risk factors for delayed graft function (DGF) in pediatric living donor kidney transplant recipients.
- To evaluate the impact of DGF on post-transplant outcomes, including graft survival and rejection rates.
- To provide insights for optimizing donor-recipient matching to mitigate DGF risks.
Main Methods:
- A retrospective analysis of the STARfile database was conducted for pediatric patients receiving living donor kidney transplants between 2000 and 2020.
- Recipient and donor demographic data, along with transplant outcomes, were analyzed.
- Delayed graft function (DGF) was defined as the requirement for dialysis within the first week post-transplantation.
Main Results:
- Out of 6480 pediatric living donor kidney transplants, 269 (4.2%) experienced DGF.
- Smaller recipient weight (<15 kg) was significantly associated with a higher incidence of DGF.
- Recipients with DGF had doubled length of stay, increased rejection rates, and markedly worse 1-year allograft survival (67% vs. 98%).
Conclusions:
- Delayed graft function (DGF) in pediatric living donor kidney transplant recipients is linked to significantly poorer allograft survival.
- Identifying and mitigating risk factors, such as small recipient size, is essential.
- Optimizing donor-recipient matching strategies may improve long-term outcomes for these patients.
Background:
Pediatric recipients of living donor kidneys have a low rate of delayed graft function (DGF). We examined the incidence, risk factors and outcomes of DGF in pediatric patients who received a living donor allograft.
Methods:
The STARfile was queried to examine all pediatric patients transplanted with a living donor kidney between 2000 and 2020. Donor and recipient demographic data were examined, as were survival and outcomes. Recipients were stratified into DGF and no DGF groups. DGF was defined as the need for dialysis within the first week after transplant.
Results:
6480 pediatric patients received a living donor (LD) kidney transplant during the study period. 269 (4.2%) developed DGF post-transplant. Donors were similar in age, creatinine, and cold ischemia time. Recipients of kidneys with DGF were similar in age, sensitization status and HLA mismatch. Focal segmental glomerulosclerosis (FSGS) was the most common diagnosis in recipients with DGF, and allograft thrombosis was the most common cause of graft loss in this group. Small recipients (weight < 15 kg) were found to have a significantly higher rate of DGF. Length of stay doubled in recipients with DGF, and rejection rates were higher post-transplant. Recipients of LD kidneys who developed DGF had significantly worse 1 year allograft survival (67% vs. 98%, p < .0001).
Conclusions:
Pediatric living donor kidney transplant recipients who experience DGF have significantly poorer allograft survival. Optimizing the donor and recipient matching to avoid compounding risks may allow for better outcomes.
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