Previous registry analyses have reported inferior graft survival rates when using laparoscopically procured organs and those with the greatest size mismatches between donor and recipient. However previous datasets reporting such anomalies are subject to large levels of heterogeneity.

Using national data we analysed a cohort of living donor paediatric recipients in two transplant centres between 1969 and 2015 with specific reference to their kidney donor demographic and operative characteristics: specifically donor age, BMI, sex, ethnicity, body surface area (BSA) ratio, donor operation laterality (right v left kidney), laparoscopic v open approach and intraperitoneal v retroperitoneal approach. Graft survival rates were compared between these 2 groups using Kaplan-Meier survival curves, log rank test and adjusted risk ratios generated using the Mantel-Haenszel (MH) model.

282 paediatric transplants were analysed. Mean age was 9.1 years (Min 1 year Max 16 years, SD 4.9) with 56.6% female preponderance. Median follow up was 41 months (IQR 11 – 126 months). 5 year graft survival was 86% (95% CI 80 – 90) and 10 year graft survival was 76% (95% CI 68% – 82%). 52% of kidneys were laparoscopically procured overall but in the last 15 years 81% were laparoscopic.

Univariate log rank test analyses revealed no difference in graft survival rates between laparoscopic versus open live donor kidneys (p=0.57), BSA mismatched kidneys (p=0.1), obese donor kidneys (p=0.6) or kidneys from donors with proteinuria (p=0.29) or hypertension (p=0.86). Similarly arterial multiplicity did not adversely impact on graft survival (p=0.74). Donor and recipient ethnicity as well as right sided kidney donation were associated with poorer graft survival on univariate analyses, however on MH modelling only right sided kidneys were related to adverse graft survival (RR 3.8 95% CI 1.3 – 11.6). This added risk was sustained even when correcting for multiple arteries (RR 4 95% CI 1.4 -12.6).

Contrary to previous reports laparoscopic and donor-recipient mismatched procurement does not adversely impact on graft survival in paediatric live donor transplantation. This data has new implications for donor operative planning for paediatric transplantation. Further study of the national database based on laterality of living kidney donation is being undertaken.

CITATION INFORMATION: Ahmed Z, Uwechue R, Chandak P, Stojanovic J, Kessaris N, Mamode N. The Impact of Donor Procurement Characteristics in Contemporary Live Donor Pediatric Renal Transplantation Outcomes: An Analysis of 282 Cases. Am J Transplant. 2016;16 (suppl 3).

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