Living unrelated renal transplantation: A good match for the pediatric candidate?

Kyle J. Van Arendonk, Babak J. Orandi, Nathan T. James, Dorry L. Segev, Paul M. Colombani

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1277-1282
Number of pages6
JournalJournal of pediatric surgery
Volume48
Issue number6
DOIs
StatePublished - Jun 1 2013

Keywords

  • Donor type
  • Graft survival
  • Pediatric kidney transplantation

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health

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