Order of donor type in pediatric kidney transplant recipients requiring retransplantation

Kyle J. Van Arendonk, Nathan T. James, Babak J. Orandi, Jacqueline M. Garonzik-Wang, Jodi M. Smith, Paul M. Colombani, Dorry L. Segev

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Living-donor kidney transplantation (KT) is encouraged for children with end-stage renal disease due to superior long-term graft survival compared with deceased-donor KT. Despite this, there has been a steady decrease in the use of living-donor KT for pediatric recipients. Due to their young age at transplantation, most pediatric recipients eventually require retransplantation, and the optimal order of donor type is not clear. METHODS: Using the Scientific Registry of Transplant Recipients, we analyzed first and second graft survival among 14,799 pediatric (<18 years old) recipients undergoing KT between 1987 and 2010. RESULTS: Living-donor grafts had longer survival compared with deceased-donor grafts, similarly among both first (adjusted hazard ratio [aHR], 0.78; 95% confidence interval [CI], 0.73-0.84; P<0.001) and second (aHR, 0.74; 95% CI, 0.64-0.84; P<0.001) transplants. Living-donor second grafts had longer survival compared with deceased-donor second grafts, similarly after living-donor (aHR, 0.68; 95% CI, 0.56-0.83; P<0.001) and deceased-donor (aHR, 0.77; 95% CI, 0.63-0.95; P=0.02) first transplants. Cumulative graft life of two transplants was similar regardless of the order of deceased-donor and living-donor transplantation. CONCLUSIONS: Deceased-donor KT in pediatric recipients followed by living-donor retransplantation does not negatively impact the living-donor graft survival advantage and provides similar cumulative graft life compared with living-donor KT followed by deceased-donor retransplantation. Clinical decision-making for pediatric patients with healthy, willing living donors should consider these findings in addition to the risk of sensitization, aging of the living donor, and deceased-donor waiting times.

Original languageEnglish (US)
Pages (from-to)487-493
Number of pages7
JournalTransplantation
Volume96
Issue number5
DOIs
StatePublished - Sep 11 2013

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Keywords

  • Donor selection
  • Donor type
  • Graft survival
  • Pediatric kidney transplantation
  • Retransplantation

ASJC Scopus subject areas

  • Transplantation

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