Abstract: TH-PO961

Donor and Recipient Size Mismatch Is Associated with Graft Survival in Pediatric Living Donor Kidney Transplantation

Session Information

Category: Transplantation

  • 1702 Transplantation: Clinical and Translational

Authors

  • Wasik, Heather Lynn, Johns Hopkins University, Baltimore, Maryland, United States
  • Ruebner, Rebecca, Johns Hopkins University, Baltimore, Maryland, United States
  • Pruette, Cozumel S., Johns Hopkins University, Baltimore, Maryland, United States
  • Segev, Dorry L., Johns Hopkins University, Baltimore, Maryland, United States
  • Massie, Allan, Johns Hopkins University, Baltimore, Maryland, United States
Background

Studies in adults and adolescents have shown that a small donor body size in relation to recipient body size is associated with increased risk of graft loss following kidney transplantation. Little is known about this relationship in young children undergoing living donor kidney transplantation (LDKT) in whom greater size mismatch is possible.

Methods

We studied first-time LDKT recipients 1995-2015 aged <11y at transplant using SRTR data. Patients were divided into two groups based on donor/recipient body surface area ratio (D/R BSA ratio): BSA ratio ≤ 2 and BSA ratio > 2. Multivariable Cox models were used to compare time to death-censored graft failure (DCGF) between patients in the two BSA ratio groups, adjusting for recipient, donor, and clinical characteristics including recipient age at transplant, recipient BSA, sex, race, cause of ESRD, years of dialysis prior to transplant, donor age, donor/recipient sex mismatch, number of HLA mismatches, and year of transplant.

Results

Of 1,948 pediatric patients undergoing LDKT, 352 (18%) had a D/R BSA ratio ≤ 2. Patients with BSA ratio ≤ 2 had a higher incidence of DCGF compared to those with a BSA ratio > 2 (32.3% at 10 years vs. 15.4%, logrank p <0.001). After adjustment, D/R BSA ratio ≤ 2 remained associated with an increased risk of DCGF (aHR (95% CI)=1.62 (1.10-2.39), p=0.01).

Conclusion

Low D/R BSA ratio is associated with increased risk of DCGF in children undergoing LDKT. Donor size may be an important factor to consider when selecting organs for pediatric LDKT.

Funding

  • Other NIH Support