Back to Search
Start Over
Pediatric deceased donor kidney transplant outcomes under the Kidney Allocation System.
- Source :
-
American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons [Am J Transplant] 2019 Nov; Vol. 19 (11), pp. 3079-3086. Date of Electronic Publication: 2019 May 28. - Publication Year :
- 2019
-
Abstract
- The Kidney Allocation System (KAS) has resulted in fewer pediatric kidneys being allocated to pediatric deceased donor kidney transplant (pDDKT) recipients. This had prompted concerns that post-pDDKT outcomes may worsen. To study this, we used SRTR data to compare the outcomes of 953 pre-KAS pDDKT (age <18 years) recipients (December 4, 2012-December 3, 2014) with the outcomes of 934 post-KAS pDDKT recipients (December 4, 2014-December 3, 2016). We analyzed mortality and graft loss by using Cox regression, delayed graft function (DGF) by using logistic regression, and length of stay (LOS) by using negative binomial regression. Post-KAS recipients had longer pretransplant dialysis times (median 1.26 vs 1.07 years, P = .02) and were more often cPRA 100% (2.0% vs 0.1%, P = .001). Post-KAS recipients had less graft loss than pre-KAS recipients (hazard ratio [HR]: <subscript>0.35</subscript> 0.54 <subscript>0.83</subscript> , P = .005) but no statistically significant differences in mortality (HR: <subscript>0.29</subscript> 0.72 <subscript>1.83</subscript> , P = .5), DGF (odds ratio: <subscript>0.93</subscript> 1.32 <subscript>1.93</subscript> , P = .2), and LOS (LOS ratio: <subscript>0.96</subscript> 1.06 <subscript>1.19</subscript> , P = .4). After adjusting for donor-recipient characteristics, there were no statistically significant post-KAS differences in mortality (adjusted HR: <subscript>0.37</subscript> 1.04 <subscript>2.92</subscript> , P = .9), DGF (adjusted odds ratio: <subscript>0.94</subscript> 1.41 <subscript>2.13</subscript> , P = .1), or LOS (adjusted LOS ratio: <subscript>0.93</subscript> 1.04 <subscript>1.16</subscript> , P = .5). However, post-KAS pDDKT recipients still had less graft loss (adjusted HR: <subscript>0.38</subscript> 0.59 <subscript>0.91</subscript> , P = .02). KAS has had a mixed effect on short-term posttransplant outcomes for pDDKT recipients, although our results are limited by only 2 years of posttransplant follow-up.<br /> (© 2019 The American Society of Transplantation and the American Society of Transplant Surgeons.)
- Subjects :
- Adolescent
Adult
Child
Death
Delayed Graft Function etiology
Delayed Graft Function pathology
Female
Follow-Up Studies
Graft Rejection etiology
Graft Rejection pathology
Graft Survival
Humans
Kidney Transplantation adverse effects
Male
Prognosis
Risk Factors
Young Adult
Delayed Graft Function mortality
Graft Rejection mortality
Kidney Failure, Chronic surgery
Kidney Transplantation mortality
Resource Allocation statistics & numerical data
Tissue Donors supply & distribution
Tissue and Organ Procurement statistics & numerical data
Subjects
Details
- Language :
- English
- ISSN :
- 1600-6143
- Volume :
- 19
- Issue :
- 11
- Database :
- MEDLINE
- Journal :
- American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons
- Publication Type :
- Academic Journal
- Accession number :
- 31062464
- Full Text :
- https://doi.org/10.1111/ajt.15419