Department of Surgery, University of Cambridge, Cambridge, United Kingdom.
Department of Paediatric Nephrology, Nottingham University Hospitals, Nottingham, United Kingdom.
Front Immunol. 2023 Jun 2;14:1207145. doi: 10.3389/fimmu.2023.1207145. eCollection 2023.
The UK kidney offering scheme introduced a kidney donor risk index (UK-KDRI) to improve the utility of deceased-donor kidney allocations. The UK-KDRI was derived using adult donor and recipient data. We assessed this in a paediatric cohort from the UK transplant registry.
We performed Cox survival analysis on first kidney-only deceased brain-dead transplants in paediatric (<18 years) recipients from 2000-2014. The primary outcome was death-censored allograft survival >30 days post-transplant. The main study variable was UK-KDRI derived from seven donor risk-factors, categorised into four groups (D1-low risk, D2, D3 and D4-highest risk). Follow-up ended on 31-December-2021.
319/908 patients experienced transplant loss with rejection as the main cause (55%). The majority of paediatric patients received donors from D1 donors (64%). There was an increase in D2-4 donors during the study period, whilst the level of HLA mismatching improved. The KDRI was not associated with allograft failure. In multi-variate analysis, increasing recipient age [adjusted HR and 95%CI: 1.05(1.03-1.08) per-year, p<0.001], recipient minority ethnic group [1.28(1.01-1.63), p<0.05), dialysis before transplant [1.38(1.04-1.81), p<0.005], donor height [0.99 (0.98-1.00) per centimetre, p<0.05] and level of HLA mismatch [Level 3: 1.92(1.19-3.11); Level 4: 2.40(1.26-4.58) versus Level 1, p<0.01] were associated with worse outcomes. Patients with Level 1 and 2 HLA mismatches (0 DR +0/1 B mismatch) had median graft survival >17 years regardless of UK-KDRI groups. Increasing donor age was marginally associated with worse allograft survival [1.01 (1.00-1.01) per year, p=0.05].
Adult donor risk scores were not associated with long-term allograft survival in paediatric patients. The level of HLA mismatch had the most profound effect on survival. Risk models based on adult data alone may not have the same validity for paediatric patients and therefore all age-groups should be included in future risk prediction models.
英国肾脏供体方案引入了肾脏供体风险指数（UK-KDRI），以提高已故供体肾脏分配的实用性。该 UK-KDRI 是使用成人供体和受者数据推导出来的。我们在英国移植登记处的儿科队列中评估了这一点。
我们对 2000 年至 2014 年间进行的首次儿童（<18 岁）接受者的单肾脑死亡供体移植后 30 天以上的死亡校正移植物存活情况进行 Cox 生存分析。主要结局是移植后>30 天的移植物存活无排斥反应。主要研究变量是由七个供体风险因素组成的 UK-KDRI，分为四组（D1-低风险、D2、D3 和 D4-最高风险）。随访截止日期为 2021 年 12 月 31 日。
319/908 例患者发生移植失败，排斥反应是主要原因（55%）。大多数儿科患者接受来自 D1 供体的供体（64%）。在研究期间，D2-4 供体数量增加，而 HLA 错配水平有所改善。KDRI 与移植物衰竭无关。多变量分析显示，受者年龄增加[校正 HR 和 95%CI：每增加 1 岁为 1.05（1.03-1.08），p<0.001]、受者少数族裔[1.28（1.01-1.63），p<0.05]、移植前透析[1.38（1.04-1.81），p<0.005]、供体身高[每增加 1%为 0.99（0.98-1.00），p<0.05]和 HLA 错配水平[级别 3：1.92（1.19-3.11）；级别 4：2.40（1.26-4.58）与级别 1，p<0.01]与较差的结局相关。具有 1 级和 2 级 HLA 错配（0 DR +0/1 B 错配）的患者无论 UK-KDRI 组如何，中位移植物存活时间均>17 年。供体年龄的增加与移植物存活时间的略微减少相关[每年增加 1.01（1.00-1.01），p=0.05]。
成人供体风险评分与儿科患者的长期移植物存活无关。HLA 错配水平对存活的影响最大。基于成人数据的风险模型可能不适用于儿科患者，因此未来的风险预测模型应包括所有年龄组。
