Living unrelated renal transplantation: A good match for the pediatric candidate?

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• 作者：Kyle J. Van Arendonk ; Babak J. Or ; i ; Nathan T. James ; Dorry L. Segev ; Paul M. Colombani
• 关键词：Pediatric kidney transplantation ; Donor type ; Graft survival
• 刊名：Journal of Pediatric Surgery
• 出版年：2013
• 出版时间：June, 2013
• 年：2013
• 卷：48
• 期：6
• 页码：1277-1282
• 全文大小：441 K

文摘

Background/purpose

Living donor kidney transplantation is encouraged for children with end-stage renal disease given the superior survival of living donor grafts, but pediatric candidates are also given preference for kidneys from younger deceased donors.

Methods

Death-censored graft survival of pediatric kidney-only transplants performed in the U.S. between 1987-2012 was compared across living related (LRRT) (n = 7741), living unrelated (LURT) (n = 618), and deceased donor renal transplants (DDRT) (n = 8945) using Kaplan-Meier analysis, multivariable Cox proportional hazards models, and matched controls analysis.

Results

As expected, HLA mismatch was greater among LURT compared to LRRT (p < 0.001). Unadjusted graft survival was lower, particularly long-term, for LURT compared to LRRT (p = 0.009). However, LURT graft survival was still superior to DDRT graft survival, even when compared only to deceased donors under age 35 (p = 0.002). The difference in graft survival between LURT and LRRT was not seen when adjusting for HLA mismatch, year of transplantation, and donor and recipient characteristics using a Cox model (aHR = 1.04, 95 % CI: 0.87-1.24, p = 0.7) or matched controls (HR = 1.02, 95 % CI: 0.82-1.27, p = 0.9).

Conclusion

Survival of LURT grafts is superior to grafts from younger deceased donors and equivalent to LRRT grafts when adjusting for other factors, most notably differences in HLA mismatch.