Abstract
Pediatric kidney transplant outcomes associated with expanded-criteria donors (ECD) and high Kidney Donor Profile Index (KDPI) kidneys are unknown. We reviewed the Scientific Registry of Transplant Recipients data from 1987-2017 to identify 96 ECD and 92 > 85 KDPI kidney recipients (<18 years). Using propensity scores, we created comparison groups of 375 non-ECD and 357 ≤ 85 KDPI recipients for comparisons with ECD and > 85 KDPI transplants, respectively. We used Cox regression for patient/graft survival and sequential Cox approach for survival benefit of ECD and > 85 KDPI transplantationvs remaining on the waitlist. After adjustment, ECD recipients were at significantly increased risk of graft failure (adjusted hazard ratio [aHR] = 1.6; P =.001) but not of mortality (aHR = 1.33; P =.15) compared with non-ECD recipients. We observed no survival benefit of ECD transplants vs remaining on the waitlist (aHR = 1.05; P =.83). We found no significant difference in graft failure (aHR = 1.27; P =.12) and mortality (aHR = 1.41; P =.13) risks between > 85 KDPI and ≤ 85 KDPI recipients. However, > 85 KDPI transplants were associated with a survival benefit vs remaining on the waitlist (aHR = 0.41; P =.01). ECD transplantation in children is associated with a high graft loss risk and no survival benefit, whereas > 85 KDPI transplantation is associated with a survival benefit for children vs remaining on the waitlist.
Original language | English (US) |
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Pages (from-to) | 1160-1170 |
Number of pages | 11 |
Journal | American Journal of Transplantation |
Volume | 21 |
Issue number | 3 |
DOIs | |
State | Published - Jul 24 2020 |
Bibliographical note
Publisher Copyright:© 2020 The American Society of Transplantation and the American Society of Transplant Surgeons
Keywords
- clinical research/practice
- donors and donation: deceased
- donors and donation: extended criteria
- kidney transplantation/nephrology
- paediatrics