TY - JOUR
T1 - Pediatric deceased donor kidney transplant outcomes under the Kidney Allocation System
AU - Jackson, Kyle R.
AU - Zhou, Sheng
AU - Ruck, Jessica
AU - Massie, Allan B.
AU - Holscher, Courtenay
AU - Kernodle, Amber
AU - Glorioso, Jaime
AU - Motter, Jennifer
AU - Neu, Alicia
AU - Desai, Niraj
AU - Segev, Dorry L.
AU - Garonzik-Wang, Jacqueline
N1 - Funding Information:
Dr Jackson is supported by grant F32DK113719 from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Dr Holscher is supported by grant F32DK109662 from the NIDDK and the American College of Surgeons Resident Research Scholarship. Dr Kernodle is supported by grant F32DK117563 from the NIDDK. Dr Massie is supported by grant K01DK101677 from the NIDDK. Dr Segev is supported by grants R01DK098431 and K24DK101828 from the NIDDK. Dr Garonzik‐Wang is supported by grant K23DK115908 from the NIDDK and a Clinician Scientist Development Award from the Doris Duke Charitable Research Foundation. The analyses described here are the responsibility of the authors alone and do not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the US government.
Funding Information:
The data reported here have been supplied by the Minneapolis Medical Research Foundation (MMRF) as the contractor for the Scientific Registry of Transplant Recipients (SRTR). The interpretation and reporting of these data are the responsibility of the author(s) and in no way should be seen as an official policy of or interpretation by the SRTR or the US government.
Funding Information:
Dr Jackson is supported by grant F32DK113719 from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Dr Holscher is supported by grant F32DK109662 from the NIDDK and the American College of Surgeons Resident Research Scholarship. Dr Kernodle is supported by grant F32DK117563 from the NIDDK. Dr Massie is supported by grant K01DK101677 from the NIDDK. Dr Segev is supported by grants R01DK098431 and K24DK101828 from the NIDDK. Dr Garonzik-Wang is supported by grant K23DK115908 from the NIDDK and a Clinician Scientist Development Award from the Doris Duke Charitable Research Foundation. The analyses described here are the responsibility of the authors alone and do not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the US government.
Publisher Copyright:
© 2019 The American Society of Transplantation and the American Society of Transplant Surgeons
PY - 2019/11/1
Y1 - 2019/11/1
N2 - The Kidney Allocation System (KAS) has resulted in fewer pediatric kidneys being allocated to pediatric deceased donor kidney transplant (pDDKT) recipients. This had prompted concerns that post-pDDKT outcomes may worsen. To study this, we used SRTR data to compare the outcomes of 953 pre-KAS pDDKT (age <18 years) recipients (December 4, 2012–December 3, 2014) with the outcomes of 934 post-KAS pDDKT recipients (December 4, 2014–December 3, 2016). We analyzed mortality and graft loss by using Cox regression, delayed graft function (DGF) by using logistic regression, and length of stay (LOS) by using negative binomial regression. Post-KAS recipients had longer pretransplant dialysis times (median 1.26 vs 1.07 years, P =.02) and were more often cPRA 100% (2.0% vs 0.1%, P =.001). Post-KAS recipients had less graft loss than pre-KAS recipients (hazard ratio [HR]: 0.350.540.83, P =.005) but no statistically significant differences in mortality (HR: 0.290.721.83, P =.5), DGF (odds ratio: 0.931.321.93, P =.2), and LOS (LOS ratio: 0.961.061.19, P =.4). After adjusting for donor–recipient characteristics, there were no statistically significant post-KAS differences in mortality (adjusted HR: 0.371.042.92, P =.9), DGF (adjusted odds ratio: 0.941.412.13, P =.1), or LOS (adjusted LOS ratio: 0.931.041.16, P =.5). However, post-KAS pDDKT recipients still had less graft loss (adjusted HR: 0.380.590.91, P =.02). KAS has had a mixed effect on short-term posttransplant outcomes for pDDKT recipients, although our results are limited by only 2 years of posttransplant follow-up.
AB - The Kidney Allocation System (KAS) has resulted in fewer pediatric kidneys being allocated to pediatric deceased donor kidney transplant (pDDKT) recipients. This had prompted concerns that post-pDDKT outcomes may worsen. To study this, we used SRTR data to compare the outcomes of 953 pre-KAS pDDKT (age <18 years) recipients (December 4, 2012–December 3, 2014) with the outcomes of 934 post-KAS pDDKT recipients (December 4, 2014–December 3, 2016). We analyzed mortality and graft loss by using Cox regression, delayed graft function (DGF) by using logistic regression, and length of stay (LOS) by using negative binomial regression. Post-KAS recipients had longer pretransplant dialysis times (median 1.26 vs 1.07 years, P =.02) and were more often cPRA 100% (2.0% vs 0.1%, P =.001). Post-KAS recipients had less graft loss than pre-KAS recipients (hazard ratio [HR]: 0.350.540.83, P =.005) but no statistically significant differences in mortality (HR: 0.290.721.83, P =.5), DGF (odds ratio: 0.931.321.93, P =.2), and LOS (LOS ratio: 0.961.061.19, P =.4). After adjusting for donor–recipient characteristics, there were no statistically significant post-KAS differences in mortality (adjusted HR: 0.371.042.92, P =.9), DGF (adjusted odds ratio: 0.941.412.13, P =.1), or LOS (adjusted LOS ratio: 0.931.041.16, P =.5). However, post-KAS pDDKT recipients still had less graft loss (adjusted HR: 0.380.590.91, P =.02). KAS has had a mixed effect on short-term posttransplant outcomes for pDDKT recipients, although our results are limited by only 2 years of posttransplant follow-up.
KW - clinical research/practice
KW - delayed graft function (DGF)
KW - graft survival
KW - health services and outcomes research
KW - kidney transplantation/nephrology
KW - patient survival
KW - pediatrics
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U2 - 10.1111/ajt.15419
DO - 10.1111/ajt.15419
M3 - Article
C2 - 31062464
AN - SCOPUS:85074205696
SN - 1600-6135
VL - 19
SP - 3079
EP - 3086
JO - American Journal of Transplantation
JF - American Journal of Transplantation
IS - 11
ER -