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A donor risk index for graft loss in pediatric living donor kidney transplantation
Author(s) -
Wasik Heather L.,
Pruette Cozumel S.,
Ruebner Rebecca L.,
McAdams-DeMarco Mara A.,
Zhou Sheng,
Neu Alicia M.,
Segev Dorry L.,
Massie Allan B.
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.15360
Subject(s) - medicine , hazard ratio , interquartile range , kidney transplantation , kidney , abo blood group system , urology , transplantation , cumulative incidence , renal function , proportional hazards model , incidence (geometry) , gastroenterology , surgery , confidence interval , physics , optics
Pediatric kidney transplant candidates often have multiple potential living donors ( LDs ); no evidence‐based tool exists to compare potential LDs , or to decide between marginal LDs and deceased donor ( DD ) kidney transplantation ( KT ). We developed a pediatric living kidney donor profile index (P‐ LKDPI ) on the same scale as the DD KDPI by using Cox regression to model the risk of all‐cause graft loss as a function of living donor characteristics and DD KDPI . HLA ‐B mismatch ( adjusted hazard ratio [aHR] per mismatch = 1.04 1.27 1.55 ), HLA ‐ DR mismatch ( aHR per mismatch = 1.02 1.23 1.49 ), ABO incompatibility ( aHR = 1.20 3.26 8.81 ), donor systolic blood pressure ( aHR per 10 mm Hg = 1.01 1.07 1.18 ), and donor estimated GFR (eGFR; aHR per 10 mL/min/1.73 m 2 = 0.88 0.94 0.99 ) were associated with graft loss after LDKT . Median (interquartile range [ IQR] ) P‐ LKDPI was −25 (−56 to 12). 68% of donors had P‐ LKDPI <0 (less risk than any DD kidney) and 25% of donors had P‐ LKDPI >14 (more risk than median DD kidney among pediatric KT recipients during the study period). Strata of LDKT recipients of kidneys with higher P‐ LKDPI had a higher cumulative incidence of graft loss (39% at 10 years for P‐ LDKPI ≥20, 28% for 20> P‐ LKDPI ≥−20, 23% for −20 > P‐ LKDPI ≥−60, 19% for P‐ LKDPI <−60 [log rank P < .001]). The P‐ LKDPI can aid in organ selection for pediatric KT recipients by allowing comparison of potential LD and DD kidneys.