RISK FACTORS FOR RENAL ALLOGRAFT SURVIVAL FROM PEDIATRIC CADAVER DONORS

Abstract

327 The shortage of cadaver donors for kidney transplantation has prompted many centers to use kidneys from pediatric donors. The results after kidney transplantation with the use of pediatric donors are suboptimal compared to adult donors. This study, using UNOS database, analyzes the risk factors for renal allograft survival with the use of pediatric kidneys. Recipients receiving cadaveric kidneys from pediatric and adult donors between 1989-1995 with a minimum of 1 year follow-up were analyzed. The actuarial kidney survival estimated by Kaplan-Meier method for donors age 0-17 years (N=12,831) at 1, 3 and 5 years was 81.4%, 71.3% and 62.1%. The corresponding results for donors age 18-50 years (N=35,428) was 83.5%, 73.3% and 62.9%, respectively (Log-rank test, p=0.001). Recipients were further divided into three groups according to pediatric donor age: Group I (0-5 yrs), Group II (6-11 yrs), Group III (12-17 yrs). The actuarial survival (%) estimated by Kaplan-Meier method for the three groups is as follows:TableThe prevalence of graft failure due to graft thrombosis was much higher in donors in Group I, 10.1% compared with Group II, 6.6% and Group III, 1.7%. Although the recipients in Group I had the poorest survival, enbloc grafts(N=749) had a much better 1, 3 and 5 year graft survival (76.3%, 67.7% and 62.7%) compared with single grafts (N=1,448) (71.9%, 60.6% and 53.4%, Log-rank test, p=0.0074) from donors 0-5 years. Logistic regression analysis of 1 year graft survival was used to identify various risk factors for Groups I-III. In Group I, the following factors were identified as increasing the odds of graft failure: increasing cold ischemic time (odds ratio [OR]=1.551, p=0.002), black recipients (OR=1.354, p=0.01), and previous txn (OR=1.551, p=0.02). Group I recipients of enbloc kidneys had a decreased odds of graft failure (OR=0.687, p=0.001). Increasing donor age was associated with a decreased odds of graft failure in Group I (OR=0.885, p=0.0001) and in Group II (OR=0.901, p=0.0002). Increased cold ischemic time, previous txn and black recipients continued to have a detrimental effect on graft survival in Groups II and III. In conclusion, 1) Poorer cadaveric kidney survival was seen in pediatric donor transplants; 2) transplant kidney survival with enbloc kidneys was better than a single kidney from donors between 0-5 years; 3) progressive increase in donor age up to 11 years was associated with improved graft survival as measured by decreasing OR; 4) there is a higher rate of graft thrombosis in younger donors.