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Kidney Week

Abstract: PO2557

Donor Biopsy and Kidney Transplant Outcomes in Pediatric Recipients

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Mashmoushi, Ahmad, University of Texas Southwestern Medical Center, Division of Pediatric Nephrology, Department of Pediatrics, Dallas, Texas, United States
  • Hwang, Christine S., University of Texas Southwestern Medical Center, Division of Surgical Transplantation, Department of Surgery, Dallas, Texas, United States
  • Macconmara, Malcolm, University of Texas Southwestern Department of Surgery, Dallas, Texas, United States
Background

Deceased Donor DD kidney biopsies are routinely used in the context of clinical concerns about donor quality in adult kidney transplants. We sought to examine the use of DD kidney biopsies in pediatric transplants. We aim to evaluate prognostic utility of glomerulosclerosis GS level in predicting graft outcomes.

Methods

Data was used from recipients who received kidney transplant between 1994 and 2018 documented in the Scientific Registry of Transplant Recipients database. Pediatric recipients were defined as recipients < 18 years who received DD kidney transplant excluding multi-organ transplants. The recepients were further stratified according to degree of donor kidney GS into 0-5% and > 5% categories. Demographic and outcome data were examined and graft survival was evaluated using STATA 16.

Results

10,045 pediatric recipients received DDKT during this period. 644 had left and/or right DD kidney biopsies, 548 biopsies had 0-5% GS, 96 biopsies had > 5% GS. Biopsies were mostly performed on kidneys harvested from higher risk donors. There was a significant difference in the number of biopsies performed across regions (region 5 lowest at 2.6% and region 9 highest at 17.5%). There was no significant difference among share characteristics or transplant center volume. Allograft survival was significantly worse for donor kidneys with GS>5% compared to 0-5% group and no biopsy group. There was no significant difference in the incidence of DGF, acute rejection, or chronic rejection.

Conclusion

Although the biopsied kidneys are mostly from higher risk donors, the majority of biopsies have GS level 0-5%. At this level of GS there is no difference in allograft survival compared to DD kidneys without biopsies. Thus utilizing kidneys with GS 0-5% can expand the DD kidney pool and should be strongly considered for use in pediatric population.

Kaplan-Meier curve of 5-year allograft survival for pediatric kidney transplant patients by donor kidney glomerular sclerosis (GS)