Use of expanded-criteria donors and > 85 KDPI kidneys for pediatric kidney transplantation in the United States

Pediatric kidney transplant outcomes associated with expanded-criteria donors (ECD) and high Kidney Donor Profile Index (KDPI) kidneys are unknown. We reviewed the Scientific Registry of Transplant Recipients data from 1987-2017 to identify 96 ECD and 92 > 85 KDPI kidney recipients (<18 years). Using propensity scores, we created comparison groups of 375 non-ECD and 357 <= 85 KDPI recipients for comparisons with ECD and > 85 KDPI transplants, respectively. We used Cox regression for patient/graft survival and sequential Cox approach for survival benefit of ECD and > 85 KDPI transplantationvs remaining on the waitlist. After adjustment, ECD recipients were at significantly increased risk of graft failure (adjusted hazard ratio [aHR] = 1.6;P = .001) butnotof mortality (aHR = 1.33;P = .15) compared with non-ECD recipients. We observed no survival benefit of ECD transplants vs remaining on the waitlist (aHR = 1.05;P = .83). We found no significant difference in graft failure (aHR = 1.27;P = .12) and mortality (aHR = 1.41;P = .13) risks between > 85 KDPI and <= 85 KDPI recipients. However, > 85 KDPI transplants were associated with a survival benefit vs remaining on the waitlist (aHR = 0.41;P = .01). ECD transplantation in children is associated with a high graft loss risk and no survival benefit, whereas > 85 KDPI transplantation is associated with a survival benefit for children vs remaining on the waitlist.

Automated summary

The study found that in pediatric kidney transplants, outcomes differ between ECD and high KDPI transplants. ECD transplants carry a higher risk of graft failure, while high KDPI transplants offer a survival benefit.