Living unrelated renal transplantation: a good match for the pediatric candidate? J Pediatr Surg 2013 Jun;48(6):1277-82
Date
07/13/2013Pubmed ID
23845618DOI
10.1016/j.jpedsurg.2013.03.023Scopus ID
2-s2.0-84880012087 (requires institutional sign-in at Scopus site) 18 CitationsAbstract
BACKGROUND/PURPOSE: Living donor kidney transplantation is encouraged for children with end-stage renal disease given the superior survival of living donor grafts, but pediatric candidates are also given preference for kidneys from younger deceased donors.
METHODS: Death-censored graft survival of pediatric kidney-only transplants performed in the U.S. between 1987-2012 was compared across living related (LRRT) (n=7741), living unrelated (LURT) (n=618), and deceased donor renal transplants (DDRT) (n=8945) using Kaplan-Meier analysis, multivariable Cox proportional hazards models, and matched controls analysis.
RESULTS: As expected, HLA mismatch was greater among LURT compared to LRRT (p<0.001). Unadjusted graft survival was lower, particularly long-term, for LURT compared to LRRT (p=0.009). However, LURT graft survival was still superior to DDRT graft survival, even when compared only to deceased donors under age 35 (p=0.002). The difference in graft survival between LURT and LRRT was not seen when adjusting for HLA mismatch, year of transplantation, and donor and recipient characteristics using a Cox model (aHR=1.04, 95% CI: 0.87-1.24, p=0.7) or matched controls (HR=1.02, 95% CI: 0.82-1.27, p=0.9).
CONCLUSION: Survival of LURT grafts is superior to grafts from younger deceased donors and equivalent to LRRT grafts when adjusting for other factors, most notably differences in HLA mismatch.
Author List
Van Arendonk KJ, Orandi BJ, James NT, Segev DL, Colombani PMMESH terms used to index this publication - Major topics in bold
AdolescentAge Factors
Child
Child, Preschool
Female
Follow-Up Studies
Graft Survival
Humans
Infant
Infant, Newborn
Kidney Failure, Chronic
Kidney Transplantation
Living Donors
Male
Registries
Survival Analysis
Treatment Outcome
United States
Unrelated Donors
