University College London Great Ormond Street Institute of Child Health, London, UK.
NHS Blood and Transplant, Bristol, UK.
Pediatr Nephrol. 2018 Sep;33(9):1609-1616. doi: 10.1007/s00467-018-3969-4. Epub 2018 May 28.
The outcome of organs which have been declined for paediatric recipients is not known. This study aimed to determine the outcome of kidneys initially declined for paediatric recipients and establish renal allograft survival in kidneys that were eventually transplanted.
Data were obtained from the UK Transplant Registry for all donation after brain death (DBD) kidneys offered and declined to paediatric recipients (< 18 years) in the UK from 2009 to 2014.
Eighty-two percent (503/615) of kidneys initially declined for paediatric transplantation were eventually transplanted, 7% (46/615) of kidneys went to paediatric recipients and 62% (384/615) of kidneys went to adult (kidney only) recipients. The remainder were used for multiple organ transplants. In the 46 kidneys that went to paediatric recipients, 1 and 3-year renal allograft survivals were 89% (95% CI 75.8-95.3%) and 82% (95% CI 67.1-90.6%), respectively. In the 384 kidneys given to adult kidney-only recipients, 1 and 3-year renal allograft survivals were 96% (95% CI 93.5-97.6%) and 94% (95% CI 90.7-96.1%), respectively. Eighty-four percent of the 204 children who initially had an offer declined on their behalf were eventually transplanted and have a functioning graft at a median 3-year follow-up.
This study reports acceptable short-term renal allograft survival in kidneys that were initially declined for paediatric recipients and subsequently transplanted. Evidence-based guidelines are required to ensure that the most appropriate kidneys are selected for paediatric recipients.
对于因儿科受者而被拒绝的器官，其结局尚不清楚。本研究旨在确定最初因儿科受者而被拒绝的肾脏的结局，并确定最终移植的肾脏的肾移植存活率。
从 2009 年至 2014 年，从英国获取了英国脑死亡后捐赠者（DBD）肾脏供体中所有提供给和拒绝给儿科受者（<18 岁）的供体数据。
82%（503/615）最初因儿科移植而被拒绝的肾脏最终被移植，7%（46/615）的肾脏被用于儿科受者，62%（384/615）的肾脏被用于成人（仅肾脏）受者。其余的则用于多器官移植。在这 46 个被用于儿科受者的肾脏中，1 年和 3 年的肾移植存活率分别为 89%（95%CI75.8-95.3%）和 82%（95%CI67.1-90.6%）。在这 384 个仅用于成人肾脏的受者中，1 年和 3 年的肾移植存活率分别为 96%（95%CI93.5-97.6%）和 94%（95%CI90.7-96.1%）。在最初有供体提供但被拒绝的 204 名儿童中，84%的儿童最终被移植，并在中位 3 年随访时具有功能移植物。
本研究报告了最初因儿科受者而被拒绝但随后被移植的肾脏的可接受的短期肾移植存活率。需要循证指南来确保为儿科受者选择最合适的肾脏。
