Background: 0 mismatch kidneys have superior outcomes in primary transplant recipient. We performed Analysis UNOS database to determine the outcome of high PRA transplant pediatric recipients.

Methods: Retrospective Analysis of UNOS database 2008-2015 pediatric recipients receiving 0 mismatch kidneys. Chi Squared analysis of outcome based on Induction, maintainance immunosuppression, donor type, race, years of transplant, donor age, recipient age, cold ischemic time, cPRA and maintainance immunosuppression. Analysis stratified based on donor types. Life test procedures conducted to evaluate graft and patient survival in living and cadaveric donors based on induction therapy. PRA > 20 was used as the cut off for high risk.

Results:

Total of 47 recipients:25 Cadaveric, 8 Living. The median age 13 years, median donor age 29 years. There were 68% cadaveric, 55% male. Of the cadaveric donors 78.1% White, 6.3% Blacks, Hispanic 12.5%, Other 3.1% Among living donors 53.3% were White, 20% Blacks, Hispanic 20%, Asian 6.7%. With increasing years since 2008, there were no change in trends of 0 mismatch donors being transplanted. 25% were primary, secondary 31%, tertiary transplants accounted for 8.5% of all this cohort. DCD 0%. For Cadaveric the median cold ischemic time 21 hours, and median cPRA 87%. For Living donors: the median cold ischemic time 1 hours, and median cPRA 72% Induction: For cadaveric organs- depleting antibodies 65.6%, non-depleting 9.4%, No induction 21.9% and Combined depleting and non-depleting agent 3.1%. For maintenance MMF was used in 89.4% of recipients and Tacrolimus in 93.6%. Immunosuppression in cadaveric donors: Tac/MMF/Steroid 46.9%, Tac/MMF 40.6 and 43.6 % steroid free. For Living donors: Tac/MMF/Steroid 53.3%, Tac/MMF 40%, steroid free 40%. In Cadaveric donors Graft survival was not statistically different based on Induction therapy with p value 0.4795. In living donor graft survival was unaffected by induction therapy and excellent whether it was used or not. Patient survival showed no statistical difference by induction in cadaveric group or living donor group and was excellent 90-100% at 4 years.

Conclusion: Cadaveric donors graft and patient survival as well as living donor graft and patient survival is not statistically different based on induction therapy. Less induction is safe and feasible in 0 mismatch transplant recipients at high immunologic risk in the pediatric age group.

CITATION INFORMATION: Whittaker V, Laftavi M, Acun Z, Gruessner R, Gruessner A. The Outcome of 0 Mismatch Kidney in Pediatric Population with High Immunologic. The Impact of Induction Therapy. An Analysis of UNOS Database. Am J Transplant. 2017;17 (suppl 3).

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