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Pediatric Kidney Transplantation-Living or Deceased Donor?
Catarina Isabel Madeira Rodrigues Neves1, Ana Rita Gomes Carlos Leal2, Lídia Simões Dos Santos2
1Pediatric Nephrology Unit, Pediatric Hospital of Coimbra, Hospital and University Center of Coimbra, Coimbra, Portugal.
Insights
Pediatric kidney transplants from living donors offer better outcomes, including pre-emptive procedures and improved graft survival compared to deceased donor transplants. This highlights the importance of donor choice in pediatric end-stage renal disease management.
Area of Science:
- Pediatric Nephrology
- Transplant Surgery
- Immunogenetics
Background:
- Kidney transplantation is the optimal treatment for pediatric end-stage renal disease (ESRD).
- Donor selection is critical for long-term success in young transplant recipients due to their extended life expectancy.
- Optimizing growth, development, and quality of life are key goals in pediatric kidney transplantation.
Purpose of the Study:
- To compare short- and long-term outcomes of kidney transplantation in pediatric patients using living versus deceased donors.
- To evaluate the impact of donor type on pre-emptive transplantation rates, HLA compatibility, and graft survival.
- To inform donor selection strategies for pediatric kidney transplant recipients.
Main Methods:
- Retrospective analysis of pediatric patients (<18 years) undergoing kidney transplantation between January 1999 and December 2018.
- Comparison of outcomes between living donor kidney transplants (LDKT) and deceased donor kidney transplants (DDKT).
- Assessment of variables including pre-emptive status, HLA mismatches, donor age, hospital stay, complications, and graft/patient survival.
Main Results:
- Living donor transplants were more frequently pre-emptive (58.3% vs 4.3%) and demonstrated superior HLA compatibility (≤3 mismatches: 90.9% vs 13.0%).
- LDKT recipients experienced shorter hospital stays (8.8 vs 14.1 days) and had older donors (38.4 vs 24.3 years).
- While short-term complications and survival rates were similar, 13-year graft survival was significantly higher for LDKT (91.7% vs 72.3%).
Conclusions:
- Living donor kidney transplantation in pediatric patients is associated with a higher likelihood of pre-emptive transplantation.
- LDKT leads to improved HLA matching, shorter hospitalizations, and enhanced long-term graft survival.
- These findings underscore the significant benefits of living donation in pediatric kidney transplantation.
Background:
Kidney transplantation is ideal for children and adolescents with chronic end-stage renal disease because it offers better growth, development, and quality of life. Donor choice is vitally important in this age group, given the long life expectancy of these patients.
Methods:
A retrospective analysis of pediatric patients (<18 years) who underwent kidney transplantation from January 1999 to December/2018 was performed. Short- and long-term outcomes were compared between living and deceased donor transplants.
Results:
We included 59 pediatric kidney transplant recipients, 12 from a living donor and 47 from a deceased donor. Thirty-six (61.0%) patients were boys, and 5 (8.5%) had a retransplant. There were no differences between groups on sex, race, and weight of the recipient and donor, as well as the age and the etiology of the recipient's primary disease. Most recipients received induction immunosuppression with basiliximab and maintenance with triple therapy, with no differences between groups. Living donor transplants were mostly pre-emptive (58.3% vs 4.3%, P < .001) and had fewer HLA mismatches (≤3: 90.9% vs 13.0%, P < .001), older donors (38.4 vs 24.3 years, P < .001) and shorter hospital stays (8.8 vs 14.1 days, P = .004). There were no statistically significant differences regarding medical-surgical complications and graft or patient survival. However, we found that at 13 years post-transplant 91.7% of the living donor grafts were functioning vs 72.3% of the deceased donor grafts.
Conclusion:
Our experience points out that a living donor graft in pediatric patients is associated with a higher probability of pre-emptive transplant, shorter hospital stay, greater HLA compatibility, and increased graft survival.
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