Purpose Initial reports for pediatric kidney recipients suggested superior outcomes for open donor (ODN) compared to laparoscopic donor nephrectomy (LDN). Current outcomes based on donor type have not been evaluated in a national dataset.

Methods Nephrectomy type and center outcomes were compared using UNOS data for living donor recipients <18, 2000-2014 (n=4742), prior and multiorgan transplants excluded. Centers were grouped as: high volume (90-99^th percentile) performed >72 cases, medium (50-89^th) 13-71 and low (1-49^th) <13. Primary outcome was graft survival (GS); secondary outcomes were delayed graft function (DGF) and rejection in the first year. Univariate survival and multivariable regression analyses were performed.

Results Live donors for pediatric recipients decreased 30%, and transitioned to LDN. Unadjusted GS did not differ for ODN v LDN (1y 95% v 96%; 5y 83% v 84%; p=0.24). GS was best at high volume centers (p<0.01). Numerous factors contributed to graft failure, but not ODN v LDN.

Over the study period, DGF after LDN decreased from 11% to 3% and LDN did not predict DGF. Compared to ODN, LDN was associated with less rejection (OR 0.66, CI 0.5-0.87, p<0.01).

Conclusions Graft outcomes following LDN have improved since its introduction, making it the standard of care. Our findings indicate an important volume-outcome relationship, making the decline in live donors over the past 15 years of paramount concern.

CITATION INFORMATION: Burg J, Scott D, Roayaie K, Maynard E, Barry J, Enestvedt C. Graft Outcomes in Pediatric Kidney Transplants Are Better with Laparoscopic Donor Nephrectomy and High Volume Centers. Am J Transplant. 2016;16 (suppl 3).

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