The outcome of organs which have been declined for paediatric recipients is not known. This study aimed to determine the outcome of kidneys initially declined for paediatric recipients and establish renal allograft survival in kidneys that were eventually transplanted.
Data were obtained from the UK Transplant Registry for all donation after brain death (DBD) kidneys offered and declined to paediatric recipients (< 18 years) in the UK from 2009 to 2014.
Eighty-two percent (503/615) of kidneys initially declined for paediatric transplantation were eventually transplanted, 7% (46/615) of kidneys went to paediatric recipients and 62% (384/615) of kidneys went to adult (kidney only) recipients. The remainder were used for multiple organ transplants. In the 46 kidneys that went to paediatric recipients, 1 and 3-year renal allograft survivals were 89% (95% CI 75.8–95.3%) and 82% (95% CI 67.1–90.6%), respectively. In the 384 kidneys given to adult kidney-only recipients, 1 and 3-year renal allograft survivals were 96% (95% CI 93.5–97.6%) and 94% (95% CI 90.7–96.1%), respectively. Eighty-four percent of the 204 children who initially had an offer declined on their behalf were eventually transplanted and have a functioning graft at a median 3-year follow-up.
This study reports acceptable short-term renal allograft survival in kidneys that were initially declined for paediatric recipients and subsequently transplanted. Evidence-based guidelines are required to ensure that the most appropriate kidneys are selected for paediatric recipients.
Ojo AO, Hanson JA, Meier-Kriesche H, Okechukwu CN, Wolfe RA, Leichtman AB, Agodoa LY, Kaplan B, Port FK (2001) Survival in recipients of marginal cadaveric donor kidneys compared with other recipients and wait-listed transplant candidates. J Am Soc Nephrol 12:589–597 PubMed
Watson AR, Hayes WN, Vondrak K, Ariceta G, Schmitt CP, Ekim M, Fischbach M, Edefonti A, Shroff R, Holta T, Zurowska A, Klaus G, Bakkaloglu S, Stefanidis CJ, Stefanidos C, Van de Walle J (2013) Factors influencing choice of renal replacement therapy in European paediatric nephrology units. Pediatr Nephrol 28:2361–2368 CrossRefPubMed
Donati-Bourne J, Roberts HW, Coleman RA (2014) Donor-recipient size mismatch in paediatric renal transplantation. J Transp Secur. https://doi.org/10.1155/2014/317574
Marlais M, Martin K, Marks SD (2017) Improved renal allograft survival for pre-emptive paediatric renal transplant recipients [abstract]. Pediatr Nephrol 31:1673
Metzger RA, Delmonico FL, Feng S, Port FK, Wynn JJ, Merion RM (2003) Expanded criteria donors for kidney transplantation. J Am Soc Transplant 3(Suppl 4):114–125 CrossRef
Summers DM, Johnson RJ, Allen J, Fuggle SV, Collett D, Watson CJ, Bradley A (2010) Analysis of factors that affect outcome after transplantation of kidneys donated after cardiac death in the UK: a cohort study. Lancet 376:1301–1311 CrossRef
Goldsmith PJ, Asthana S, Fitzpatrick M, Finlay E, Attia MS, Menon KV, Pollard SG, Ridgway DM, Ahmad N (2010) Transplantation of adult-sized kidneys in low-weight pediatric recipient DMts achieves short-term outcomes comparable to size-matched grafts. Pediatri Transplant 14:919–924
NHS Blood and Transplant. Contra-indications to organ donation—resons for decline of organs for paediatric recipients. Minutes of paediatric sub-group of Kidney Advisory Group, April 2013
- Renal allograft survival rates in kidneys initially declined for paediatric transplantation
E. Jane Tizard
Stephen D. Marks
- Springer Berlin Heidelberg