Introduction: One of the strategies promoted to increase the donor pool, is to use kidneys from pediatric deceased donors, but criteria to use them en bloc (EBK) or split (SK) are not well defined. We compared the graft outcomes of pediatric donor kidneys (EBK and SK) to standard criteria donors (SCD) and expanded criteria donors (ECD) to understand the optimal use of pediatric kidneys.
Methods: A retrospective analysis of SRTR data between Jan 1993 & May 2012 was performed. Kaplan Meier death censured graft survival of EBK & SK from pediatric donors (age < 8y &wt< 30kg) was compared to SCD & ECD. One month graft survival stratified by donor weight category and EBK/SK status was assessed. We analyzed the disposition of organs in donors <25kg to identify potentially transplantable unused kidneys.
Results: Survival of 62,546 SCD & 24,879 ECD kidneys was compared to 4,718 pediatric SK& 2,669 pediatric EBK. Both EBK & SK had increased early graft loss, no worse than ECD.
One year graft survival of EBK & SK was comparable to SCD. Long term graft survival of EBK was slightly better than SK, but SK was much better than with ECD. Graft survival in the first month after transplant among EBK &SK in weight categories (5-9.9; 10-14.9; & ≥15 kg) was identical. Among a total of 10,085 pediatric donors (wt< 25kg) who had at least 1 other organ transplanted 2,000 kidneys were not recovered, 809 were recovered but not transplanted, 433 were ineligible as consent was not requested, & consent was not obtained for 180. In pediatric donors weighing ≥5 kg, 2,491 kidneys were transplanted EB which could potentially have been used as SK. If all donor kidneys were used as SK, 5,913 (328/year) more organs might have been used.
Conclusion: 1.Graft survival of EBK is slightly better than SCD but graft survival in SK is similar to SCD. 2. Kidneys from donors ≥ 5 kg can be successfully transplanted as SK, expanding the donor pool. 3. Reasons for non-use of kidneys from patients < 25kg who had at least 1other organ used for a transplant is unknown but we believe a significant proportion could have been successfully transplanted.
To cite this abstract in AMA style:Suneja M, Kuppachi S, Katz D, Hunsicker L. Pediatric Kidneys Can Be Used To Expand the Donor Pool: An Analysis of Scientific Registry of Transplant Recipients Data [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/pediatric-kidneys-can-be-used-to-expand-the-donor-pool-an-analysis-of-scientific-registry-of-transplant-recipients-data/. Accessed October 27, 2020.
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