39 - Outcomes of living unrelated donor kidney transplants in children: An Organ Procurement and Transplant Network (OPTN) database analysis
Saturday, April 23, 2022
3:30 PM – 6:00 PM US MT
Poster Number: 39 Publication Number: 39.235
Lavjay Butani, University of California Davis, Sacramento, CA, United States; Daniel J. Tancredi, University of California, Davis, School of Medicine, Sacramento, CA, United States
Professor University of California Davis University of California Davis Sacramento, California, United States
Background: There are limited and conflicting data on long-term outcomes and the survival benefit afforded by living unrelated donor (LURD) renal transplants (Tx) compared to Tx from other donor sources, in children.
Objective: To compare graft survival rates in pediatric recipients of LURD kidneys, compared to deceased donor (DD) and living related donor (LRD) kidneys, using the national OPTN database.
Design/Methods: A log-linear event history regression model for time to graft failure (graft loss or patient death) categorized by donor source, statistically adjusting for important confounders (such as HLA mismatch, cause of renal disease, ischemia times etc.) was applied to pediatric recipients of 1st kidney only transplants, using data from the OPTN database from 2000-2021.
Results: Of the 12103 pediatric Tx recipients (41% female), 327 (2.7%) received kidneys from LURD, 4353 (36%) from LRD and 7423 (61%) from DD. 5952 (49%) and 3104 (25.6%) of the recipients were of Non-Hispanic white and Hispanic ethnicity respectively; 71% of the recipients had received pre-Tx dialysis. Delayed graft function was noted in 6% of Tx. One year graft failure rate was 3.55%. On multivariate regression analyses, compared to LRD recipients, LURD recipients had a comparable graft survival and DD recipients had lower graft survival (table 1). When using the LURD recipients as the reference group, DD recipients had comparable graft survival albeit with a wide 95th percentile confidence interval for the hazard ratio for graft failure. Other predictors of graft failure included recipient sex (female) and race-ethnicity (black), pre-Tx hypoalbuminemia, need for pre-Tx dialysis and greater number of HLA mismatches.Conclusion(s): In a large cohort of pediatric renal Tx recipients, LURD kidneys have comparable graft survival to LRD kidneys; DD kidneys had the poorest survival. Our study, the largest to date, should lay rest to any controversy pertaining to this subject and should encourage centers to embrace LURD (non-commercial) kidneys as a viable option for children needing Tx, and a preferable option to DD kidneys.