Impact of End-stage Renal Disease Diagnosis on Graft Survival in Kidney Transplant Recipients of Small Pediatric Kidneys

Objective: Renal grafts from small pediatric donors have been shown to offer similar or significantly superior graft and patient outcomes compared to adult standard criteria donors. However, these grafts are susceptible to several risk factors for graft dysfunction and complications, including increased rates of vascular complications, urinary complications, acute cellular rejection, and delayed graft function. Some of this risk may be augmented by the environment into which these grafts are transplanted. End-stage renal disease (ESRD) etiology of the recipient may be a risk factor for poor outcomes following kidney transplant (KTX) from small pediatric donors.

Methods: SRTR data (1995-2016) of adult KTX recipients from deceased donors age <5 years and weight 10-21 kg was compared to ideal adult deceased donors (defined as: age 18–34 years; without a history of HTN, DM, CVA as cause of death, or Cr>1.5). Only recipients with ESRD due to diabetes mellitus (DM), hypertension (HTN), immune-mediated disease (IMD), and Other patients (ESRD etiology no longer impacts the graft following KTX, e.g., PCKD) were included.

Results: Multivariate analysis demonstrated worse overall graft survival following pediatric single kidney (SK) transplantation in all groups (HTN [aHR=1.57, 95% CI=1.25-1.98], DM [aHR=1.34, 95%CI=1.06-1.70], IMD [aHR=1.58, 95% CI=1.11-2.26], and Other patients [aHR=1.53, 95%CI=1.09-2.14]), but ESRD etiology was not associated with outcomes following pediatric en bloc (EBK) transplantation. Patient survival was not impacted by graft type.

Conclusion: This study suggests no role in using recipient ESRD diagnosis to determine whether a patient is a suitable candidate for a graft of a single small pediatric donor kidney.