ESPN 53rd Annual Meeting

ESPN 2021


 
Improving allograft survival by informing donor selection in kidney transplant recipients under 5 years old
FLORIAN MANCA BARAYRE 1 LARRY A GREENBAUM 3 ROUBA GARRO 3 CHIA-SHI WANG 3 PAMELA D WINTERBERG 3 RACHEL PATZER 4 JULIEN HOGAN 2

1- EMORY UNIVERSITY SCHOOL OF MEDICINE, ATLANTA, USA
2- ROBERT-DEBRĂ© HOSPITAL, APHP, PARIS, FRANCE
3- CHILDREN’S HEALTHCARE OF ATLANTA, ATLANTA, USA
4- DEPARTMENT OF EPIDEMIOLOGY, ROLLINS SCHOOL OF PUBLIC HEALTH, EMORY UNIVERSITY, ATLANTA, USA
 
Abstract:

Objectives: The US kidney allocation system aims at allocating high-quality kidneys to pediatric recipients but the score used to assess the quality of the donors (KDPI) may not accurately predict graft survival in pediatric recipients. We aimed at assessing KDPI accuracy to predict graft loss in pediatric recipients and at developing predictive models of graft loss for deceased and living donor transplants to inform donor selection.

Methods: We included first-time kidney transplantations in pediatric recipients from the US SRTR database of adult donors from 2005 to 2018. The primary outcome was defined as death or graft loss. We developed a Small Pediatric-KDPI (SP-KDPI) and Small Pediatric-Living KDPI (SP-LDKPI) on the same scale to compare each other by using Cox models adjusted for recipients characteristics.

Results: KDPI C-statistic was 0.52 and was not associated with graft survival in recipients under 5 years old. Six deceased donor factors were included in SP-KDPI computation: ethnicity, age, body surface area, gender, cold ischemia time, HLA-B mismatches number. Four living donor factors were included in SP-LKDPI computation: race, age, HLA-B mismatch number and donor/recipient body surface area ratio. Model accuracies were validated internally by cross-validations and C-statistics were 0.64 (95% CI = 0.57 – 0.70) and 0.65 (95% CI = 0.58 – 0.73) for SP-KDPI and SP-LKDPI, respectively. 16.8% of living donors allograft had a negative SP-LKDPI (meaning a better predicted survival than any deceased donor).

Conclusions: The current US kidney allocation system allocates good kidneys to pediatric recipients but provides little information to guide donor selection especially in recipients < 5 years old. We developed an adaptation that demonstrated a higher accuracy to predict graft loss in young recipients and an extension of this score to accurately compare adult living and deceased donors offered to young recipients.