THE RELATIONSHIP BETWEEN DONOR EGFR AND ALLOGRAFT SURVIVAL IN PAEDIATRIC RENAL TRANSPLANT RECIPIENTS

Abstract

Introduction: Renal transplantation is the gold standard treatment for end-stage kidney disease in children. The study of prognostic factors which influence renal allograft survival is important to optimise individual patient outcomes and guide decisions regarding allograft allocation. This study tested the null hypothesis that donor eGFR is not associated with renal allograft survival in the deceased donor paediatric renal transplant population in the United Kingdom. Methods: A twenty-year, historical cohort analysis of all paediatric (under 18 years of age), single kidney, deceased donor transplant procedures performed in the United Kingdom. The data was sourced from the UK Organ Donation and Transplantation (ODT) registry by the National Health Service Blood and Transplant (NHSBT) between 1 Jan 1999 and 31 Dec 2019. Donor estimated glomerular filtration rate (eGFR) was presented as a three-level ordered categorical variable, consisting >90, 60 - 90 and <60mls/min/1.73m2 (Groups 1, 2 and 3 respectively). Outcome was death-censored renal allograft survival, defined as the time in days from transplantation to either pre-emptive retransplantation or the initiation of renal replacement therapy. Children with functioning renal transplantation at last follow-up were censored from the analysis. The time to renal allograft failure was analysed with Kaplan Meier survival method and the Cox proportional hazards model used to calculate multivariable hazard ratios for renal allograft failure in relation to increasing eGFR status. Results and Discussion: 1,296 paediatric renal transplant recipients (60% male) with median recipient age of 12 years (range: 0 - 17) at transplantation were transplanted with 64.9% (841), 24.6% (319) and 10.5% (136) having donor eGFR in Groups 1, 2 and 3 respectively. Ten-year renal allograft survival proportion in Groups 1, 2 and 3 respectively were 68.5% (95%CI 64.8 - 72.3%), 66.9% (95%CI 61 - 73.3%) and 64.6 (95%CI 55.6 - 75.2%; Kaplan Meier analysis in Figure 1).A multivariable Cox regression model was fitted to 397 observations of renal allograft failure. Data were consistent with the null hypothesis of no association between increasing donor eGFR status and renal allograft survival, after adjustment for donor/recipient sex and age, HLA A/B/DR mismatch, and donor diabetes mellitus/hypertension status (Figure 2). There was no evidence for important effect modification between donor eGFR and hazard of renal allograft failure with respect to donor hypertension or diabetes status.Conclusion: Data from this study are consistent with the null hypothesis of no association between donor eGFR and renal allograft survival in paediatric renal transplant recipient with the caveat that usually the aim is to use the best organs for children. Nevertheless, further prospective studies in different settings with larger sample sizes are required to confirm this conclusion. This project was supported by the National Institute for Health Research (NIHR) Biomedical Research Centre at Great Ormond Street Hospital for Children NHS Foundation Trust and University College London. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.