Background: With the prioritization of age ≤ 18 years old at the time of registration on the kidney transplant waiting list in the United States, deceased donor rates have increased. Majority of these patients require subsequent transplantation at a later time. Previous transplant has shown an impact on posttransplant outcomes. We hypothesized that recipients of those previous pediatric deceased donor kidney transplant (DDKT) would have worse posttransplant outcomes after the second KT than those after living donor KT (LDKT).

Materials and Methods: We used data from the Organ Procurement Transplant Network (OPTN/UNOS) as of December 8, 2016. A retrospective cohort analysis was created to examine the outcome of 1,930 recipients being second-time kidney transplanted at age 18-30 from January 1, 2000, to September 30, 2015, with previous KT at age less than 18. Those with more than two kidney transplant episodes or multiorgan transplant were excluded. Patients were divided into two groups according to donor type of the first pediatric KT; 1) those with failed DDKT and 2) those with failed LDKT.

Results: Recipients of the first LDKT group were more likely to be Caucasian and have subsequent LDKT compared to the first DDKT group. (Table1) We found an increase in median time to second KT since first graft failure and second registration in recipients with previous pediatric DDKT. The median PRA was higher in those with failed DDKT as well as higher number of patients with high PRA (>80%) and very high PRA (≥98%).(Table2) Looking at the outcome after the second KT, rejection rate, graft survival of the first DDKT group were similar to the first LDKT group, however, recipients of previous LDKT were more likely to have better GFR at 3 years after the second KT. (Table3)

Conclusions: Recipients with previously failed pediatric DDKT had higher PRA and longer waiting time before re-transplantation. However, kidney allograft outcomes after the second KT were comparable. It would be preferable to perform LDKT as the first kidney transplant in childhood and adolescence to minimize their waiting times in the future.

CITATION INFORMATION: Phonphok K., Duong T., Panombualert S., Bunnapradist S. Outcome of Second Kidney Transplantation According to Previous Pediatric Donor Type: A Retrospective Cohort Analysis Am J Transplant. 2017;17 (suppl 3).

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