Optimizing Kidney Allograft Years: Underutilization of Pediatric Donors

The Kidney Donor Profile Index (KDPI) score drives kidney allocation in the United States for both adult and pediatric donors, despite the calculation being primarily derived from adult donor data. A KDPI of ≤20% is considered to have the longest graft survival potential and is typically prioritized for recipients who have a low Estimated Posttransplant Survival (EPTS) score. Using KDPI to assess pediatric donor quality may underestimate graft survival and result in underutilization of these kidneys for recipients with a low EPTS score.

Using Scientific Registry of Transplant Recipients data, we analyzed 5-y posttransplant death-censored graft survival of kidneys from donors aged 0-<4, 4-<8, 8-<12, and 12-<18 y compared with adult donor kidneys with a KDPI of ≤20% to adult recipients using Kaplan-Meier analysis, pairwise comparisons, and multivariate Cox proportional models.

Death-censored graft survival was not significantly different for pediatric donors aged 8-<12 y (χ² = 0.8, P = 0.37) and 12-<18 y (χ² = 0.23, P = 0.63) when compared with adult donor kidneys. Five-year graft survival was 91.8%, 92.3%, and 92.4%, respectively, with a mean KDPI of 37.5% (range, 1%-85%), 16.2% (range, 0%-85%), and 10.7% (range, 0%-19%) and mean EPTS score of 42.9%, 29.9%, and 22.8%, respectively.

Graft survival for kidneys from donors aged 8-18 y is not inferior to that of adult donors with a KDPI of ≤20%. These data support the use of pediatric donors aged 8 y and older for those recipients who traditionally received adult donor kidneys with a KDPI of ≤20%.