Long-term Outcomes of Single and Dual En Bloc Kidney Transplants From Small Pediatric Donors: An ANZDATA Registry Study

Jacques G Eastment; Elizabeth G Ryan; Scott Campbell; Mark Ray; Andrea K Viecelli; Dev Jegatheesan; Vijay Kanagarajah; Anthony Griffin; John M Preston; David W Johnson; Nicole Isbel

doi:10.1097/TXD.0000000000001518

Long-term Outcomes of Single and Dual En Bloc Kidney Transplants From Small Pediatric Donors: An ANZDATA Registry Study

Transplant Direct. 2023 Jul 21;9(8):e1518. doi: 10.1097/TXD.0000000000001518. eCollection 2023 Aug.

Authors

Jacques G Eastment^{1

2}, Elizabeth G Ryan^{3

4}, Scott Campbell^{1

2

5

6

7}, Mark Ray^{1

2}, Andrea K Viecelli^{1

3

5

6}, Dev Jegatheesan^{1

3

5

7}, Vijay Kanagarajah^{1

2}, Anthony Griffin^{1

2}, John M Preston^{1

2}, David W Johnson^{1

2

5

6

7}, Nicole Isbel^{1

2

5

6

7}

Affiliations

¹ Queensland Kidney Transplant Service, Princess Alexandra Hospital, Brisbane, Australia.
² School of Medicine, University of Queensland, Brisbane, Australia.
³ Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia.
⁴ QCIF Facility for Advanced Bioinformatics, Institute for Molecular Bioscience, The University of Queensland, Brisbane, Australia.
⁵ Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia.
⁶ Translational Research Institute, Brisbane, Australia.
⁷ Centre for Kidney Disease Research, University of Queensland, Brisbane, Australia.

Abstract

Kidney transplants from small pediatric donors are considered marginal and often transplanted as dual grafts. This study aimed to compare long-term outcomes between recipients of single kidney transplants (SKTs) and dual en bloc kidney transplants (EBKTs) from small pediatric donors.

Methods: Data were obtained from the Australia and New Zealand Dialysis and Transplant Registry. All adult recipients of kidney transplants from donors aged ≤5 y were identified. The primary outcome of interest was death-censored graft survival by donor type. The secondary outcomes were early graft loss, delayed graft function, serum creatinine posttransplantation, acute rejection, and patient survival.

Results: There were 183 adult recipients of kidney transplants from donors aged ≤5 y old. Of these, 60 patients had EBKT grafts, 79 patients had SKT grafts, and 44 patients had grafts of unknown type. Compared with SKT donors, EBKT donors had lower mean age (P < 0.001) and body weight (P < 0.001). There was no significant difference in death-censored graft survival between the groups, with median survival of 23.8 y (interquartile range 21.2-25) in the EBKT cohort and 21.8 y (11.6-26.8) in the SKT cohort (hazard ratio 1.3; 95% confidence interval, 0.59-2.64; P = 0.56). EBKT grafts had lower acute rejection rates than SKT grafts (P = 0.014). There was no significant difference observed between groups with respect to early graft loss, delayed graft function, posttransplantation serum creatinine posttransplantation, or patient survival.

Conclusions: EBKT and SKTs from small pediatric donors are associated with excellent long-term graft survival rates.