LONG-TERM GRAFT SURVIVAL OF EN BLOC OR SINGLE KIDNEY TRANSPLANTS FROM SMALL PEDIATRIC DECEASED DONORS

Abstract

P352 Aims: Optimal use of kidneys from small pediatric deceased donors remains unresolved. Some groups advocate single rather than en bloc transplantation of these organs to maximize the number of recipients who could benefit from transplantation, postulating that outcomes from single transplants are equivalent to those achievable with en bloc grafts. In this study, we compared long-term graft survival in recipients of en bloc and single renal transplants from small pediatric donors in a large national registry cohort. Methods: Using data from the U.S. Scientific Registry of Transplant Recipients, we studied a cohort of recipients who received kidney transplants between 1993 and 2002 (n=2454) from small pediatric donors (weight <21 kg). Donor and recipient characteristics by procedure type (en bloc or single) were compared by chi-square test. A Cox regression model was used to determine the relative risk of graft failure in recipients of en bloc and single renal transplants, adjusting for recipient age, race, ethnicity, gender, diagnosis, and body weight. Results: The cohort included 1161 recipients of single kidneys and 1293 recipients of en bloc transplants from small pediatric donors. Young (age <5 years), very small (donor weight of ≤7 kg), and female donor kidneys were more likely (p<0.05) to be transplanted en bloc, while kidneys from donors whose cause of death was stroke were less likely (p<0.05) to be transplanted en bloc. Hispanic, pediatric, and sensitized (PRA ≥80) recipients were less likely (p<0.05) to receive an en bloc transplant. After adjusting for differences in recipient characteristics, patients who received single kidney transplants from small pediatric donors had a significantly higher risk of graft failure compared with recipients of en bloc kidney transplants (RR=1.45, p<0.0001). Conclusions: Recipients of en bloc kidney transplants from small pediatric donors have significantly better long-term graft outcomes compared with recipients of single kidneys from these donors. These data suggest that graft outcome is compromised by allocation of these organs as single grafts.Figure