Division of Nephrology, Department of Medicine, Kidney and Pancreas Transplant Research Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
Division of Nephrology, Department of Medicine, Rajavithi Hospital, Bangkok, Thailand.
Pediatr Transplant. 2020 Nov;24(7):e13800. doi: 10.1111/petr.13800. Epub 2020 Jul 28.
Under the current kidney allocation system, pediatric candidates listed prior to age 18 receive priority for high-quality deceased donor organs. This has resulted in a decline in living donor transplantation in pediatrics, despite superior outcomes of living donor transplantation. Due to a young age at transplantation, most pediatric kidney transplant recipients require re-transplantation. The effects of a previously failed deceased donor vs a previously failed living donor on re-transplant candidates are unknown.
Using the United Network for Organ Sharing database, we examined 2772 re-transplant recipients aged 18-30 years at time of relisting for second KT from 2000 to 2018 with history of prior pediatric KT (age ≤ 18 years).
PFLDKT recipients compared to those with PFDDKT had shorter median waiting times and dialysis time regardless of their second donor type (14.0 vs 20.3 months, and 19.1 vs 34.5 months, respectively). PFLDKT recipients had higher re-transplant rates (adjusted HR 1.17, 95% CI 1.09-1.27, and adjusted HR 1.05, 95% CI 0.95-1.15 when calculating from time of relisting and time of returning to dialysis, respectively). PFDDKT recipients were more likely to have higher median PRA levels (90% vs 73%).
Re-transplant candidates who received a previous deceased donor as a child had a higher level of sensitization, longer waiting time, and dialysis exposure compared to those with PFLDKT. Among primary pediatric kidney transplant candidates, consideration should be considered for living donor transplantation, despite the priority for deceased donor organs, to avoid increased sensitization and longer waiting times for with re-transplantation.
在当前的肾脏分配系统下，18 岁以下的儿科候选人优先获得高质量的已故供体器官。这导致儿科活体供体移植数量下降，尽管活体供体移植的结果更好。由于移植时年龄较小，大多数儿科肾移植受者需要再次移植。先前已故供体失败与先前活体供体失败对再次移植候选人的影响尚不清楚。
使用美国器官共享网络数据库，我们检查了 2000 年至 2018 年间 2772 名再次移植受者的病史，这些受者在再次列出名单时年龄为 18-30 岁，之前接受过儿科肾移植（年龄≤18 岁）。
与 PFDDKT 受者相比，无论第二次供体类型如何，PFLDKT 受者的中位等待时间和透析时间都更短（分别为 14.0 个月与 20.3 个月，19.1 个月与 34.5 个月）。PFLDKT 受者的再次移植率更高（从再次列出名单的时间和返回透析的时间计算，调整后的 HR 分别为 1.17（95%CI 1.09-1.27）和 1.05（95%CI 0.95-1.15））。PFDDKT 受者更有可能具有更高的中位 PRA 水平（90%对 73%）。
与 PFLDKT 受者相比，作为儿童接受先前已故供体的再次移植候选人具有更高的致敏水平、更长的等待时间和透析暴露。在原发性儿科肾移植候选人中，尽管优先考虑已故供体器官，但应考虑活体供体移植，以避免再次移植时致敏增加和等待时间延长。
