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The impact of donor/recipient age difference and HLA mismatch on graft outcome in pediatric kidney transplantation
Author(s) -
Trnka Peter,
McTaggart Steven J.,
Francis Anna
Publication year - 2018
Publication title -
pediatric transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.457
H-Index - 69
eISSN - 1399-3046
pISSN - 1397-3142
DOI - 10.1111/petr.13265
Subject(s) - medicine , retrospective cohort study , kidney transplantation , propensity score matching , transplantation , cohort , kidney , human leukocyte antigen , kidney transplant , surgery , pediatrics , immunology , antigen
Background Understanding the relationship between the factors that influence long‐term kidney transplant survival remains a key priority for pediatric nephrologists. We assessed the relative impact of donor/recipient age difference and HLA matching on long‐term graft outcomes. Methods We conducted a retrospective cohort study of pediatric and adolescent recipients who received a primary kidney transplant in Australia and New Zealand between January 1, 1990, and December 31, 2015. The primary outcome was graft survival analyzed by Kaplan–Meier method. Results During the 26‐year period, 1134 primary (395 DD and 739 LD) kidney transplants were performed in recipients less than 20 years of age. The median follow‐up time was 10.2 years. Overall, 405 patients (35.7%) lost their transplant with graft survival 93.8% at 1 year, 82.5% at 5 years, 65.8% at 10 years, and 49.9% at 15 years post‐transplant. There was consistently higher graft loss of DD kidneys as compared to LD kidneys at each time point. Both increasing donor/recipient age difference ( aHR 1.11 per 10 years; 95% CI , 1.02‐1.20; P = 0.009) and increasing HLA mismatch ( aHR 1.20 per mismatch; 95% CI , 1.10‐1.30; P < 0.001) were associated with decreased graft survival. Conclusions Donor/recipient age difference and HLA matching are important factors influencing long‐term graft outcomes in pediatric kidney transplantation. HLA mismatch remains a strong predictor of graft loss. For patients without the option of a LD, we suggest that the degree of HLA mismatch should not be discounted as part of the decision‐making process of organ allocation.