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Utilizing increased risk for disease transmission (IRD) kidneys for pediatric renal transplant recipients

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Abstract

Background

Strategies to expand numbers of deceased donor kidneys suitable for pediatric recipients are urgently needed to prevent long-term dialysis-associated morbidity and mortality. Donors designated as increased risk of disease transmission (IRD) are infrequently used in pediatric recipients. We examined outcomes of these kidneys in pediatric patients and the potential to increase the donor pool.

Methods

The United Network for Organ Sharing (UNOS) database records presence of IRD in all deceased donors since 2004. All pediatric kidney transplant recipients from 2004 to 2017 were identified and stratified by IRD status, and outcomes were examined.

Results

Four hundred seventy-three pediatric kidney transplant recipients received an IRD allograft. IRD donors had lower kidney donor profile index (KDPI); were more likely to be younger, male, and Caucasian; and were more likely to have used drugs. IRD kidneys were more likely to have been biopsied and placed on pulsatile perfusion. Other than an older recipient age, demographic data were not different between groups. Allograft and patient survivals were similar, as were rejection and delayed graft function rates. Compared with adult recipients and adult IRD recipients, pediatric recipients were more likely to have a younger donor, receive a kidney with a lower creatinine, and were less likely to have delayed graft function (p < 0.05). There were no recorded disease transmissions in IRD group.

Conclusions

Patient and allograft survivals are similar in IRD and non-IRD kidneys. High-quality IRD organs used in adults represent a large number of donors with excellent outcomes. IRD allografts have a potential to increase transplant volume and should be considered for pediatric patients.

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Authors and Affiliations

  1. Division of Surgical Transplantation, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA

    Christine S. Hwang & Malcolm MacConmara

  2. Division of Pediatric Transplantation, Children’s Medical Center, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., 4th Floor, Dallas, TX, 75390-856, USA

    Christine S. Hwang & Malcolm MacConmara

  3. Division of Nephrology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA

    Jyothsna Gattineni

Authors
  1. Christine S. Hwang
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  2. Jyothsna Gattineni
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  3. Malcolm MacConmara
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Contributions

Christine S. Hwang: first author, gathered, organized, and analyzed the data and wrote the manuscript.

Jyothsna Gattineni: participated in reviewing the manuscript.

Malcolm MacConmara: participated in gathering, organizing, and performing data analysis and writing the manuscript.

All authors have approved the manuscript as submitted.

Corresponding author

Correspondence to Christine S. Hwang.

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Conflict of interest

The authors declare that they have no conflict of interest.

Disclaimer

The data reported here were supplied by the Minneapolis Medical Research Foundation as the contractor for the SRTR. The interpretation and reporting of these data are the responsibility of the author(s) and in no way, should be an official policy of or interpretation by the SRTR or the US government.

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Hwang, C.S., Gattineni, J. & MacConmara, M. Utilizing increased risk for disease transmission (IRD) kidneys for pediatric renal transplant recipients. Pediatr Nephrol 34, 1743–1751 (2019). https://doi.org/10.1007/s00467-019-04276-w

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  • DOI: https://doi.org/10.1007/s00467-019-04276-w

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