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Kidney transplant outcomes associated with the use of increased risk donors in children
Author(s) -
Kizilbash Sarah J.,
Rheault Michelle N.,
Wang Qi,
Vock David M.,
Chinnakotla Srinath,
Pruett Tim,
Chavers Blanche M.
Publication year - 2019
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/ajt.15231
Subject(s) - medicine , hazard ratio , kidney transplant , proportional hazards model , kidney , kidney transplantation , multivariate analysis , confidence interval , urology
Increased risk donors ( IRD s) may inadvertently transmit blood‐borne viruses to organ recipients through transplant. Rates of IRD kidney transplants in children and the associated outcomes are unknown. We used the Scientific Registry of Transplant Recipients to identify pediatric deceased donor kidney transplants that were performed in the United States between January 1, 2005 and December 31, 2015. We used the Cox regression analysis to compare patient and graft survival between IRD and non‐ IRD recipients, and a sequential Cox approach to evaluate survival benefit after IRD transplants compared with remaining on the waitlist and never accepting an IRD kidney. We studied 328 recipients with and 4850 without IRD transplants. The annual IRD transplant rates ranged from 3.4% to 13.2%. IRD s were more likely to be male ( P = .04), black ( P < .001), and die from head trauma ( P = .006). IRD recipients had higher mean cPRA (0.085 vs 0.065, P = .02). After multivariate adjustment, patient survival after IRD transplants was significantly higher compared with remaining on the waitlist (adjusted hazard ratio [ aHR ]: 0.48, 95% CI : 0.26‐0.88, P = .018); however, patient ( aHR : 0.93, 95% CI : 0.54‐1.59, P = .79) and graft survival ( aHR : 0.89, 95% CI : 0.70‐1.13, P = .32) were similar between IRD and non‐ IRD recipients. We recommend that IRD s be considered for transplant in children.