TY - JOUR
T1 - Living unrelated renal transplantation
T2 - A good match for the pediatric candidate?
AU - Van Arendonk, Kyle J.
AU - Orandi, Babak J.
AU - James, Nathan T.
AU - Segev, Dorry L.
AU - Colombani, Paul M.
N1 - Funding Information:
The data reported here have been supplied by the Minneapolis Medical Research Foundation as the contractor for the SRTR. The interpretation and reporting of these data are the responsibility of the authors and in no way should be seen as an official policy of or interpretation by the SRTR or the U.S. government.
PY - 2013/6
Y1 - 2013/6
N2 - 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.
AB - 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.
KW - Donor type
KW - Graft survival
KW - Pediatric kidney transplantation
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U2 - 10.1016/j.jpedsurg.2013.03.023
DO - 10.1016/j.jpedsurg.2013.03.023
M3 - Article
C2 - 23845618
AN - SCOPUS:84880012087
SN - 0022-3468
VL - 48
SP - 1277
EP - 1282
JO - Journal of pediatric surgery
JF - Journal of pediatric surgery
IS - 6
ER -