Use of expanded-criteria donors and>85 KDPI kidneys for pediatric kidney transplantation in the United States.

Abstract

Pediatric kidney transplant outcomes associated with expanded-criteria donors (ECD) and high Kidney Donor Profile Index (KDPI) kidneys are unknown. We reviewed the Scientific Registry of Transplant Recipients data from 1987-2017 to identify 96 ECD and 92>85 KDPI kidney recipients (<18years). Using propensity scores, we created comparison groups of 375 non-ECD and 357≤85 KDPI recipients for comparisons with ECD and>85 KDPI transplants, respectively. We used Cox regression for patient/graft survival and sequential Cox approach for survival benefit of ECD and>85 KDPI transplantationvs remaining on the waitlist. After adjustment, ECD recipients were at significantly increased risk of graft failure (adjusted hazard ratio [aHR]=1.6; P=.001) but not of mortality (aHR=1.33; P=.15) compared with non-ECD recipients. We observed no survival benefit of ECD transplants vs remaining on the waitlist (aHR=1.05; P=.83). We found no significant difference in graft failure (aHR=1.27; P=.12) and mortality (aHR=1.41; P=.13) risks between>85 KDPI and≤85 KDPI recipients. However, > 85 KDPI transplants were associated with a survival benefit vs remaining on the waitlist (aHR=0.41; P=.01). ECD transplantation in children is associated with a high graft loss risk and no survival benefit, whereas>85 KDPI transplantation is associated with a survival benefit for children vs remaining on the waitlist.