Under the current kidney allocation system (KAS), pediatric (PED) renal transplant (RTx) candidates have a priority to kidneys from KDPI <35% donors. However, that excludes very highly sensitized (HS, CPRA 98-100%) adult RTx candidates among other exclusions. We hypothesized that graft survival (GS) and patient survival (PS) in PED RTx recipients is superior to those of adult HS RTx recipients. We analyzed OPTN data for RTx from 2005 to 2016. We analyzed 3-year PS and GS for PED RTx compared to HS adult RTx and adult RTx recipients with different degrees of sensitization using log-rank tests. We found that for KDPI <35% donors, PED RTx recipients had a better 3-year PS compared to both first time and repeat adult HS RTx recipients (p <0.0001), while 3-year GS was only superior when compared to HS adult RTx recipients with a prior Tx (p=0.0038, multiple comparisons adjusted 0.0784). For donors with KDPI 35-85%, again 3-year PS was superior in PED RTx recipients compared to HS adult RTx recipients (p<0.0001), but 3-year GS was not different. The lack of GS benefit in PED RTx recipients is an interesting finding that warrants further study. We speculate that potential causes include non-adherence in adolescent patients, recurrent disease, and technical factors in the youngest patients. Many in the pediatric RTx community have considered prioritizing HS adult candidates over PED candidates unfair. Based on this data showing poorer outcomes using similar donors, and other data showing a decline in the % of kidneys going to PED recipients after KAS, prioritizing HS adult RTx candidates with a prior RTx over PED candidates should be reconsidered.

CITATION INFORMATION: Almond P., Al-Akash S., Stewart D., Robinson A. Inferior Patient and Graft Survival in Highly Sensitized Adult Kidney Transplant Recipients with a Prior Transplant Compared to Pediatric Kidney Transplant Recipients: An Analysis of OPTN Data Am J Transplant. 2017;17 (suppl 3).

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