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. 2013 Sep 15;96(5):487-93.
doi: 10.1097/TP.0b013e31829acb10.

Order of donor type in pediatric kidney transplant recipients requiring retransplantation

Kyle J Van Arendonk  1 , Nathan T James, Babak J Orandi, Jacqueline M Garonzik-Wang, Jodi M Smith, Paul M Colombani, Dorry L Segev
Affiliations

Order of donor type in pediatric kidney transplant recipients requiring retransplantation

Kyle J Van Arendonk et al. Transplantation. .

Abstract

Background: Living-donor kidney transplantation (KT) is encouraged for children with end-stage renal disease due to superior long-term graft survival compared with deceased-donor KT. Despite this, there has been a steady decrease in the use of living-donor KT for pediatric recipients. Due to their young age at transplantation, most pediatric recipients eventually require retransplantation, and the optimal order of donor type is not clear.

Methods: Using the Scientific Registry of Transplant Recipients, we analyzed first and second graft survival among 14,799 pediatric (<18 years old) recipients undergoing KT between 1987 and 2010.

Results: Living-donor grafts had longer survival compared with deceased-donor grafts, similarly among both first (adjusted hazard ratio [aHR], 0.78; 95% confidence interval [CI], 0.73-0.84; P<0.001) and second (aHR, 0.74; 95% CI, 0.64-0.84; P<0.001) transplants. Living-donor second grafts had longer survival compared with deceased-donor second grafts, similarly after living-donor (aHR, 0.68; 95% CI, 0.56-0.83; P<0.001) and deceased-donor (aHR, 0.77; 95% CI, 0.63-0.95; P=0.02) first transplants. Cumulative graft life of two transplants was similar regardless of the order of deceased-donor and living-donor transplantation.

Conclusions: Deceased-donor KT in pediatric recipients followed by living-donor retransplantation does not negatively impact the living-donor graft survival advantage and provides similar cumulative graft life compared with living-donor KT followed by deceased-donor retransplantation. Clinical decision-making for pediatric patients with healthy, willing living donors should consider these findings in addition to the risk of sensitization, aging of the living donor, and deceased-donor waiting times.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Donor Type in First and Second Kidney Transplants among Primary Pediatric Kidney Transplant Recipients.
Figure 2
Figure 2
Patient Survival and Incidence of Retransplantation after First Graft Loss, Stratified by Donor Type of First Transplant, among Patients Receiving a Primary Pediatric Kidney Transplant.
Figure 3*
Figure 3*
A. Death-Censored Graft Survival, Stratified by Transplant Number and Donor Type, among Recipients of a Primary Pediatric Kidney Transplant, B. Death-Censored Graft Survival of Second Kidney Transplants, Stratified by Order of Donor Type, among Recipients of a Primary Pediatric Kidney Transplant who Underwent Retransplantation, and C. Cumulative Graft Life, by Percentiles, of the First Two Transplants in the D+L and L+D Groups. * DD: two deceased donor grafts; LD: living donor graft followed by deceased donor graft; DL: deceased donor graft followed by living donor graft; LL: two living donor grafts; D+L: nth percentile of graft survival times for all first deceased donor grafts added to nth percentile for second living donor grafts among those with a preceding deceased donor graft; L+D: nth percentile of graft survival times for all first living donor grafts added to nth percentile for second deceased donor grafts among those with a preceding living donor graft
Figure 3*
Figure 3*
A. Death-Censored Graft Survival, Stratified by Transplant Number and Donor Type, among Recipients of a Primary Pediatric Kidney Transplant, B. Death-Censored Graft Survival of Second Kidney Transplants, Stratified by Order of Donor Type, among Recipients of a Primary Pediatric Kidney Transplant who Underwent Retransplantation, and C. Cumulative Graft Life, by Percentiles, of the First Two Transplants in the D+L and L+D Groups. * DD: two deceased donor grafts; LD: living donor graft followed by deceased donor graft; DL: deceased donor graft followed by living donor graft; LL: two living donor grafts; D+L: nth percentile of graft survival times for all first deceased donor grafts added to nth percentile for second living donor grafts among those with a preceding deceased donor graft; L+D: nth percentile of graft survival times for all first living donor grafts added to nth percentile for second deceased donor grafts among those with a preceding living donor graft
Figure 3*
Figure 3*
A. Death-Censored Graft Survival, Stratified by Transplant Number and Donor Type, among Recipients of a Primary Pediatric Kidney Transplant, B. Death-Censored Graft Survival of Second Kidney Transplants, Stratified by Order of Donor Type, among Recipients of a Primary Pediatric Kidney Transplant who Underwent Retransplantation, and C. Cumulative Graft Life, by Percentiles, of the First Two Transplants in the D+L and L+D Groups. * DD: two deceased donor grafts; LD: living donor graft followed by deceased donor graft; DL: deceased donor graft followed by living donor graft; LL: two living donor grafts; D+L: nth percentile of graft survival times for all first deceased donor grafts added to nth percentile for second living donor grafts among those with a preceding deceased donor graft; L+D: nth percentile of graft survival times for all first living donor grafts added to nth percentile for second deceased donor grafts among those with a preceding living donor graft
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References

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