Abstract: TH-PO1152
Use of Expanded Criteria Donors for Pediatric Kidney Transplantation in the United States
Session Information
- Transplantation: Clinical - Pretransplant Management
November 07, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 1902 Transplantation: Clinical
Authors
- Kizilbash, Sarah J., University of Minnesota, Minneapolis, Minnesota, United States
- McEwen, Scott T., University of Minnesota, Minneapolis, Minnesota, United States
- Evans, Michael David, University of Minnesota, Minneapolis, Minnesota, United States
- Chavers, Blanche M., University of Minnesota, Minneapolis, Minnesota, United States
Background
The use of marginal kidneys for transplantation has increased in the recent years to expand the deceased donor pool. Transplant outcomes associated with the use of expanded criteria donors (ECD) in children are unknown.
Methods
We used the Scientific Registry of Transplant Recipients to identify all pediatric (<18 years at transplant) deceased donor kidney transplants that were performed in the US using ECD (donors older than 60 years or older than 50 years with co-morbidities) between 1987-2017.
Results
Our final cohort included 96 ECD and 375 non-ECD recipients. The demographic and baseline characteristics of donors and recipients are presented in table 1. ECD donors were older (58.4 vs. 25.1 years; p<0.001), and less likely to be males (33.3 vs. 62.4%; p<0.001). Compared with non-ECD recipients, ECD recipients were at significantly higher risk of delayed graft function (aOR: 3.2; 95% CI: 1.8 5.6; p< 0.001), graft failure (aHR: 1.6; 95% CI: 1.2 2.1; p 0.001) and mortality (aHR: 1.6; 95% CI: 1.02–2.3; p 0.01). Five-year acute rejection free survival tended to be lower in ECD vs. non-ECD recipients (24.3 vs. 34.4%; p 0.06).
Conclusion
ECD kidney transplants in children are associated with higher risks of delayed graft function, graft failure and mortality compared with matched non-ECD recipients. We recommend that kidneys from ECD donors not be considered for pediatric candidates.
Demographic and baseline characteristics of kidney transplant recipients and donors
| Variables | Expanded criteria donor recipients N = 96 | Non-expanded criteria donor recipients N = 375 | p value |
| Recipients age at transplant (years) Mean (SD) | 13.4 (4.3) | 12.7 (4.4) | 0.18 |
| Recipient gender n (%) Male | 51 (53.1) | 212 (56.5) | 0.63 |
| Recipient race n (%) White Black Other | 57 (59.4) 34 (35.4) 5 (5.2) | 235 (62.7) 117 (31.2) 23 (6.1) | 0.92 |
| Pre-emptive transplant n (%) | 13 (13.5) | 62 (16.5) | 0.58 |
| Delayed graft function n (%) | 35 (36.5) | 66 (17.6) | <0.001 |
| Age at donation (years) Mean (SD) | 58.4 (5.6) | 25.1 (14.4) | <0.001 |
| Donor gender n (%) Male | 32 (33.3) | 234 (62.4) | <0.001 |
| Donor race n (%) White Black Other | 84 (87.5) 9 (9.4) 3 (3.1) | 311 (82.9) 54 (14.4) 10 (2.7) | 0.06 |
| KDPI Mean (SD) | 82.5 (11.4) | 31.3 (23.2) | <0.001 |