Kidney Week

Abstract: SA-PO1208

Age Is Just a Number, Height Is the Hazard

Session Information

• Transplantation: Clinical - Complications, Pediatrics, and Multi-Organ Considerations
  October 24, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Transplantation

• 2002 Transplantation: Clinical

Authors

• Barani, Bahar, Children's Mercy Kansas City, Kansas City, Missouri, United States

Bahar Barani, MD

• Wadnerkar, Shivani Prashant, Children's Mercy Kansas City, Kansas City, Missouri, United States

Shivani Prashant Wadnerkar, MBBS

• Cibrik, Diane Marie, The University of Kansas Medical Center, Kansas City, Kansas, United States

Diane Marie Cibrik, MD

• Herrera, Nicholas, The University of Kansas Medical Center, Kansas City, Kansas, United States

Nicholas Herrera, MD, MS

Background

Pediatric donor kidney allografts are considered to have inferior allograft survival. We hypothesize that pediatric donors have excellent allograft outcomes and donor to recipient height mismatch is the likely cause of poor allograft survival.

Methods

This SRTR retrospective cohort study analyzed first deceased donor kidney-only transplants.Pediatric donors were compared to high-quality young adult donors.The co-exposure of interest was negative delta height (donor height minus recipient height, in centimeters).The primary outcome was death-censored graft failure, using nested cause-specific Cox proportional hazards ratios. Model A included donor age group with key covariates.Model B added delta height as a linear term.

Results

In Model A donors 0-<8 were directionally consistent with the literature supporting higher death-censored graft failure. Model B, adding negative delta height, reversed the donor-age hazard ratios. All pediatric donor age groups’ hazard ratios shifted left of the reference HR of 1.0. Negative delta height was independently associated with graft failure: for every additional centimeter the donor was shorter than the recipient, the hazard of graft failure increased by 0.8%.

Conclusion

The perceived inferiority of young pediatric kidneys is an artifact of size-related confounding. Accounting for negative delta height reveals these grafts offer up to a 40% reduction in graft-failure hazard compared to high-quality adult donors. This warrants a reassessment of current utilization and allocation strategies.

Forest plot displaying the reversal of hazard ratios for death-censored graft failure

Multivariable Cause-Specific Cox Models A and B