Introduction: Previous studies in adult kidney transplant recipients (KTRs) have shown that an increased age difference between donor and recipient increases the risk of arterial stenosis and allograft loss. The effect of donor-recipient age difference in pediatric KTRs is unclear.

Methods: We examined the relationship between donor-recipient age difference at transplant (age difference <15 vs. >15 years) and the results of protocol biopsies (Bxs) at 6, 12 and 24 months post-transplant in stable pediatric KTRs age 1-20 years old transplanted between 2005- 2016. Bxs were evaluated for subclinical rejection and chronic changes (ci/ct scores) by Banff 2015 criteria.

Results: A total of 503 protocol Bxs were analyzed. Subclinical rejection was found in 7.1%, 5.0%, and 4.5% at 6, 12, and 24 months respectively. At 6, 12, and 24 months, cases with donor-recipient age difference > 15 years had significantly higher rates of both ci and ct scores > 1 (Table 1). On sub-analysis, this difference remained significant in patients with deceased, but not living, donor transplants at 6 and 12 months (Table 1).

Conclusion: An age difference between donors and pediatric KTRs of >15 years predisposes to early interstitial fibrosis and tubular atrophy. This relationship appears to be primarily driven by findings in pediatric KTRs receiving deceased (vs. living) donor transplants.

CITATION INFORMATION: Panombualert S., Pearl M., Weng P., Ettenger R. Age Difference between Donor and Recipient Predisposes to Early Interstitial Fibrosis and Tubular Atrophy in Pediatric Kidney Transplantation Am J Transplant. 2017;17 (suppl 3).

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