Risk factors for renal allograft survival from pediatric cadaver donors: An analysis of United Network for Organ Sharing data

Background The shortage of cadaveric donors for kidney transplantation has prompted many centers to use cadaver kidneys from pediatric donors. Use of kidneys from pediatric donors has been shown to have a lower graft survival . Methods. Recipients receiving cadaver kidneys from pediatric and adult dono rs between 1988 and 1995 were analyzed. The data were obtained from United Network of Organ Sharing database. The actuarial kidney transplant graft su rvival was estimated by the Kaplan-Meier method. A logistic regression anal ysis was used to identify various risk factors for 1-year graft failure. Od ds ratios (OR) were estimated for various risk factors. Results. Kidney transplant survival rates for donor age < 18 years (n=12,83 8) at 1, 2, 3, 4, and 5 years were 81.5% 76.3%, 71.3%, 66.4%, and 61.7%, re spectively. The corresponding results for adult donors from age IS to 50 ye ars (n=35, 442) were 83.5%, 78.4%, 73.1%, 67.9%, and 62.4%, respectively, L og-rank test P <0.01. Pediatric donors were further divided into three grou ps according to donor age: group 1 (0-5 years), group II (6-11 years), and group III (12-17 years). The actuarial survival rates for 1, 3, and 5 years for group I (n=2198) were 73.6%, 63.3%, and 55.6%, respectively. The corre sponding values for group II (n=2873) were 78.0%, 67.5%,, and 57.8%, and fo r group III (n=7767) were 85%, 75.0%, and 64.8%, respectively, P <0.01. Alt hough the recipients of group I had lower graft survival, en bloc grafts (n =751) had much better 1-, 3-, and 5-year graft survival rates (76.3%, 67.7% , and 60.7%, respectively) compared with single grafts (n=1447; 72.2%,61.1% , and 53.2%, P=0.02) from donors 0 to 5 years. Graft thrombosis as a cause of graft failure was seen in 10% of group I compared with 6% in group Il an d 5% in group III. In group 1, lower OR were seen when an en bloc transplan t was performed (0.688, P <0.01) and when donor body weight was > 15 kg (0. 547, P <0.01). However, OR were elevated in recipients of previous transpla nts (1.556, P <0.01), with prolonged cold ischemic time (1.097, P=0.03), fo r black recipients (1.288, P=0.03), and for recipients with body mass index greater than or equal to 25 (1.286, P=0.02). Progressive increase in the d onor age was associated with lower OR in group II (0.894, P <0.01). Conclusions. (1) Overall, poorer graft survival was seen in pediatric donor transplants, (2) transplant kidney survival with en bloc kidneys was bette r than a single kidney from donors 0-5 years, (3) progressive increase in d onor age was associated with improved graft survival when the donors were 6 -11 years, whereas progressive increase in donor weight was associated with improved graft survival when the donors were 0-5 years.