Kidneys from living donors prove more successful in pediatric recipients
Click Here to Manage Email Alerts
Compared with kidneys from deceased donors, organs from living donors show best graft survival in pediatric patients.
However, an analysis of the Organ Procurement and Transplantation Network (OPTN) database revealed 61% of donations came from deceased donors.
“There is sometimes hesitation among transplant teams to accept donor kidneys for patients from donors who are not biologically related to the recipient — and may not even be emotionally invested/related to the donor. In addition, there is a theoretical concern that the recipient/recipient family also may not be as ‘attentive’ to the care of this precious gift, once such a transplant has occurred, due to the lack of an emotional connection with the donor in many instances,” Lavjay Butani, MD, professor of pediatrics and chief of pediatric nephrology at University of California Davis Medical Center, told Healio. “The implications of these might be that kids may end up waiting much longer for a transplanted organ (which is not good for their health and well-being) and that if they do receive such an organ, they may lose it faster to rejection or other complications. Our goal was to study how frequently transplant centers are accepting such kidneys and their long-term outcomes.”
In a retrospective cohort analysis, researchers evaluated 12,089 children who received their first kidney-only transplant between Jan. 1, 2000, and Sept. 30, 2021. No patients who experienced graft failure on the first day of the transplant were included in the study. Data were derived from the OPTN database.
Researchers considered time to graft failure or death as the primary outcome of the study.
Categorizing by donor source (deceased donor, living biologically related donor or living biologically unrelated donor) and adjusting for confounders, researchers utilized Cox event history regression models to measure the time to primary outcome.
Overall, researchers identified the 1-year graft failure rate as 3.56%. Only 2.7% of patients received kidneys from living biologically unrelated donors (n = 327), 36% from living biologically related donors (n = 4,349) and 61% from deceased donors (n = 7,413). Analyses revealed recipients of living biologically unrelated donors had comparable graft survival to recipients of living biologically related donors, and deceased donor recipients experienced lower graft survival. However, when using living unrelated kidney recipients as the reference group, researchers observed comparable graft survival among deceased donor kidney recipients.
“Our study confirms that living donor organs fare much better than deceased donor kidneys in the long term,” Butani told Healio. “Living unrelated transplants are occurring in children at an increasing frequency over the past decade and have outcomes that are comparable to living related donor transplants. This means that centers should not be hesitant about accepting living unrelated donor organs for children and should try their best to avoid dialysis and deceased donor transplants, if at all possible.”
Butani added, “We plan on continuing our studies using the large OPTN database to investigate other strategies to optimize the care of children who receive transplants and to study ways to expedite transplants in children.”
Collapse
Click Here to Manage Email Alerts