ESPN 53rd Annual Meeting

ESPN 2021


 
Kidney Paired Exchange in Children in the US
JULIEN HOGAN 1 ALVIN THOMAS 2 JENNIFER VERBESEY 3 DORRY SEGEV 4

1- DEPARTMENT OF SURGERY, EMORY UNIVERSITY, ATLANTA, GA.
2- DEPARTMENT OF EPIDEMIOLOGY, UNIVERSITY OF NORTH CAROLINA, CHAPEL HILL, NC.
3- MEDSTAR GEORGETOWN TRANSPLANT INSTITUTE, WASHINGTON, DC.
4- DEPARTMENT OF SURGERY, JOHNS HOPKINS UNIVERSITY, BALTIMORE, MD
 
Introduction:

Kidney paired exchange (KPE) plays an increasing role among adult living donor transplant (LDTx) in the US. LDTx is the treatment of choice in children with ESKD. Despite the allocation of high quality transplants from deceased donors and short waiting times in children, improving access to LDTx is of high importance. In this study, we describe the characteristics and outcomes of pediatric transplants performed through KPE.

Material and methods:

We studied 5,022 pediatric LDTx (2/2008-12/2019), including 128 National Kidney Registry (NKR) transplants, using the Scientific Registry of Transplant Recipients (SRTR) linked with the NKR database. We compared death-censored graft failure (DCGF) and mortality between NKR recipients and three control groups (1) all non-NKR SRTR living donor recipients, (2) all non-NKR unrelated SRTR living donor recipients, and (3) all non-NKR SRTR KPE recipients. 

Results:

There were 352 pediatric KPE transplants during the study period (36% participated in NKR). Among NKR pediatric recipients, 44% were female, 23% were African American (AA), 14% were Hispanic, and the median age was 16. Compared to SRTR controls, NKR pediatric participants were more often AA (23% vs 9%, p<0.001), less likely to receive preemptive transplant (28% vs. 38% p=0.02), more often had a previous transplant (27% vs. 9%), and more often had a PRA>80 (23% vs. 4%, p<0.001). NKR participants experienced longer cold ischemia times (median 8 vs. 1 hour) but did not experience increased risk of delayed graft function (4% vs 3%, p=0.6), 5-year DCGF (5% vs. 0.5%, p=0.1), or 5-year mortality (1.7% vs. 1.9%, p=0.2).

 

Conclusions:

The use of KPE to improve access to LDTx in children increased over the last decade. This especially benefited children with traditionally lower access to LDTx such as AA and highly sensitized patients and demonstrated good patients and transplant outcomes similar to non-KPE LDTx.