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Kidney Week

Abstract: TH-PO1151

Donation After Cardiac Death for Pediatric Kidney Transplantation

Session Information

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

Donations after cardiac death (DCD) constitute 20% of adult deceased-donor kidney transplants. There is a paucity of data on long-term transplant outcomes associates with the use of DCD donors in children.

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 DCD kidneys between 1987 and 2017. We used 4:1 propensity score matching (for age at transplant, gender, race, pretransplant dialysis, and transplant center and year) and exact matching by center to create a comparison group. Patient and graft survival were evaluated using mixed effects Cox proportional hazards modeling and delayed graft function using logistics regression.

Results

Our final analysis cohort included 285 DCD and 1132 non-DCD recipients. The demographic and clinical characteristics of recipients and donors are given in tables 1 and 2. DCD donors were younger (21.8 vs. 23.5 years; p 0.03), and more likely to be white (89.5 vs. 79%; p <0.001). We found no difference in 5-year graft survival (76.1% vs. 72.6%; p 0.55) and 5-year patient survival (95.1% vs. 95.7%; p 0.58) between DCD and non-DCD recipients. The differences in graft survival (aHR: 0.93; 95% CI: 0.72 – 1.3; p 0.45) and patient survival (aHR: 1.02; 95% CI: 0.60 – 1.7; p 0.99) remained insignificant after multivariate adjustment. DCD recipients demonstrated a higher risk of delayed graft function (adjusted OR: 3.2; 95% CI: 2.1 – 4.7; p <0.001).

Conclusion

Although DCD recipients are at higher risk of delayed graft function, we found no difference in 5-year patient or graft survival between DCD and matched non-DCD recipients.

Demographic and baseline characteristics of donors and recipients
VariablesDonation after cardiac death
N = 285
Non-cardiac death donation
N = 1132
p value
Recipients age at transplant (years)
Mean (SD)
13.4 (4.4)13.0 (4.6)0.12
Recipient gender n (%)
Male
162 (56.8)642 (56.7)0.99
Recipient race n (%)
White
Black
Other
187 (65.6)
74 (26.0)
24 (8.4)
755 (66.7)
297 (26.2)
80 (7.1)
0.78
Pre-emptive transplant n (%)50 (17.5)240 (21.2)0.20
Delayed graft function n (%)56 (19.6)91 (8.0)<0.01
Age at donation (years)
Mean (SD)
21.8 (9.0)23.3 (10.1)0.025
Donor gender n (%)
Male
194 (68.1)772 (68.2)0.99
Donor race n (%)
White
Black
Other
255 (89.5)
23 (8.1)
7 (2.5)
894 (79.0)
195 (17.2)
43 (3.8)
0.002
KDPI
Mean (SD)
26.7 (18.4)21.3 (18.3)< 0.01