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Am J Transplant. 2019 May 7. doi: 10.1111/ajt.15419. [Epub ahead of print]

Pediatric deceased donor kidney transplant outcomes under the Kidney Allocation System.

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Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland.
Division of Pediatric Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Scientific Registry of Transplant Recipients, Minneapolis, Minnesota.


The Kidney Allocation System (KAS) has resulted in fewer pediatric kidneys being allocated to pediatric deceased donor kidney transplant (pDDKT) recipients. This had prompted concerns that post-pDDKT outcomes may worsen. To study this, we used SRTR data to compare outcomes of 953 pre-KAS pDDKT (age<18 years) recipients (12/4/2012-12/3/2014) to 934 post-KAS pDDKT recipients (12/4/2014-12/3/2016). We analyzed mortality and graft loss using Cox regression, delayed graft function (DGF) using logistic regression, and length of stay (LoS) using negative binomial regression. Post-KAS recipients had longer pre-transplant dialysis times (median 1.26 vs. 1.07 years, p=0.02) and were more often cPRA 100% (2.0% vs. 0.1%, p=0.001). Post-KAS recipients had less graft loss than pre-KAS recipients (hazard ratio [HR]:0.35 0.540.83 , p=0.005), but no statistically significant differences in mortality (HR:0.29 0.721.83 , p=0.5), DGF (odds ratio [OR]:0.93 1.321.93 , p=0.2), and LoS (LoS ratio:0.96 1.061.19 , p=0.4). After adjusting for donor/recipient characteristics, there were no statistically significant post-KAS differences in mortality (adjusted HR [aHR]:0.37 1.042.92 , p=0.9), DGF (adjusted OR:0.94 1.412.13 , p=0.1), or LoS (adjusted LoS ratio:0.93 1.041.16 , p=0.5). However, post-KAS pDDKT recipients still had less graft loss (aHR:0.38 0.590.91 , p=0.02). KAS has had a mixed effect on short-term post-transplant outcomes for pDDKT recipients, although our results are limited by only two years of post-transplant follow-up. This article is protected by copyright. All rights reserved.


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