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. 2023 Jul 21;9(8):e1518.
doi: 10.1097/TXD.0000000000001518. eCollection 2023 Aug.

Long-term Outcomes of Single and Dual En Bloc Kidney Transplants From Small Pediatric Donors: An ANZDATA Registry Study

Jacques G Eastment  1   2 , Elizabeth G Ryan  3   4 , Scott Campbell  1   2   5   6   7 , Mark Ray  1   2 , Andrea K Viecelli  1   3   5   6 , Dev Jegatheesan  1   3   5   7 , Vijay Kanagarajah  1   2 , Anthony Griffin  1   2 , John M Preston  1   2 , David W Johnson  1   2   5   6   7 , Nicole Isbel  1   2   5   6   7
Affiliations

Long-term Outcomes of Single and Dual En Bloc Kidney Transplants From Small Pediatric Donors: An ANZDATA Registry Study

Jacques G Eastment et al. Transplant Direct. .

Abstract

Kidney transplants from small pediatric donors are considered marginal and often transplanted as dual grafts. This study aimed to compare long-term outcomes between recipients of single kidney transplants (SKTs) and dual en bloc kidney transplants (EBKTs) from small pediatric donors.

Methods: Data were obtained from the Australia and New Zealand Dialysis and Transplant Registry. All adult recipients of kidney transplants from donors aged ≤5 y were identified. The primary outcome of interest was death-censored graft survival by donor type. The secondary outcomes were early graft loss, delayed graft function, serum creatinine posttransplantation, acute rejection, and patient survival.

Results: There were 183 adult recipients of kidney transplants from donors aged ≤5 y old. Of these, 60 patients had EBKT grafts, 79 patients had SKT grafts, and 44 patients had grafts of unknown type. Compared with SKT donors, EBKT donors had lower mean age (P < 0.001) and body weight (P < 0.001). There was no significant difference in death-censored graft survival between the groups, with median survival of 23.8 y (interquartile range 21.2-25) in the EBKT cohort and 21.8 y (11.6-26.8) in the SKT cohort (hazard ratio 1.3; 95% confidence interval, 0.59-2.64; P = 0.56). EBKT grafts had lower acute rejection rates than SKT grafts (P = 0.014). There was no significant difference observed between groups with respect to early graft loss, delayed graft function, posttransplantation serum creatinine posttransplantation, or patient survival.

Conclusions: EBKT and SKTs from small pediatric donors are associated with excellent long-term graft survival rates.

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Conflict of interest statement

D.W.J. has received consultancy fees, research grants, speaker’s honoraria, and travel sponsorships from Baxter Healthcare and Fresenius Medical Care, consultancy fees from Astra Zeneca, Bayer, BI and Lilly, Vifor, and AWAK, speaker’s honoraria and travel sponsorships from ONO Pharmaceutical Co. Ltd., and travel sponsorships from Amgen. He is a current recipient of an Australian National Health and Medical Research Council (NHMRC) Leadership Investigator Grant. A.K.V. is a current recipient of an NHMRC Emerging Leadership Investigator Grant and a Queensland Advancing Clinical Research Fellowship. The other authors declare no conflicts of interest.

Figures

FIGURE 1.
FIGURE 1.
Flow diagram demonstrating study population.
FIGURE 2.
FIGURE 2.
Box plot of distribution of each type of kidney transplant over time from pediatric donors aged ≤5 y. Middle line in box represents median with upper hinge and lower hinge corresponding to 75th and 25th percentiles, respectively. Whiskers extend to upper and lower adjacent values. EBKTS, en bloc kidney transplant; SKT, singe kidney transplant.
FIGURE 3.
FIGURE 3.
Death-censoed graft survival outcomes for recipients of small paediatric donor kidneys. A) EBKT versus SKT B) EBKT versus SKT, stratified by weight and donor group. EBKT, en bloc kidney transplant; SKT, single kidney transplant.
FIGURE 4.
FIGURE 4.
Serum creatinine values for recipients of small pediatric donor kidney transplants over time. Boxplot for serum creatinine over time, by type of donor organ received. Middle line in box represents median with upper hinge and lower hinge corresponding to 75th and 25th percentiles, respectively. Whiskers extend to upper and lower adjacent values with outside values represented by dots. *** indicates significantly higher overall serum creatinine values across the SKT group. EBKT, en bloc kidney transplant; SKT, single kidney transplant.
FIGURE 5.
FIGURE 5.
Kaplan-Meier patient survival estimates (all-cause mortality) for recipients of dual en bloc and single kidney grafts from small pediatric donors. EBKT, en bloc kidney transplant; SKT, single kidney transplant.
See this image and copyright information in PMC

References

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