Strategies to Expand the Deceased Donor Pool for Pediatric Kidney Transplant Recipients.

Abstract

Kidney transplantation is the treatment of choice for children with ESKD; however, access to transplantation is limited by the escalating gap between the organ supply and demand. In 2018, only 36% of the 756 pediatric kidney transplants were living donor transplants, indicating that pediatric candidates rely heavily on the deceased donor waiting list. The prevalence of pediatric candidates on the waiting list was 1585 in December 2018 (1). The increase in prevalence is due to a combination of longer waiting times and a decline in deceased donor transplant rates. According to the annual Scientific Registry of Transplant Recipients report, pediatric deceased donor transplant rates declined by 27% from 2009 to 2018 (52/100 versus 37.9/100 waitlist-years). Of the children waitlisted in 2015, 2% died on the waiting list and 15% were still waiting by 2018 (1). Timely transplantation in children is critical for their growth and development. Compared with a functioning graft, dialysis is associated with six times lower patient survival, poorer physical growth, and inferior neurocognitive development (2). Considering the high morbidity and mortality on dialysis, we must explore strategies that would expand the deceased donor pool for children. Despite the severe organ shortage, 20% of kidneys are discarded annually in the United States. In 2019, kidneys from 4460 deceased donors were discarded (3). Of these, 50% were expanded criteria or high kidney donor profile index (KDPI) kidneys (KDPI is a numeric score denoting donor quality based on several donor characteristics), 26% were kidneys donated after cardiac death, and 23% were kidneys at risk of inadvertently transmitting HIV/hepatitis B/hepatitis C to the recipients (3). Other predictors of discard include pediatric donor age, cytomegalovirus seropositivity, hepatitis B/C seropositivity, cigarette use, diabetes, and AB blood type (4). In this article, we review pediatric kidney transplant outcomes associated with kidneys that are …