PDF(Pubmed)
Abstract：
BACKGROUND: Pediatric (age < 18 years) kidney transplant (KT) candidates face increasingly complex choices. The 2014 kidney allocation system nearly doubled wait times for pediatric recipients. Given longer wait times and new ways to optimize compatibility, more pediatric candidates may consider kidney-paired donation (KPD). Motivated by this shift and the potential impact of innovations in KPD practice, we studied pediatric KPD procedures in the US from 2008 to 2021.
METHODS: We describe the characteristics and outcomes of pediatric KPD recipients with comparison to pediatric non-KPD living donor kidney transplants (LDKT), pediatric LDKT recipients, and pediatric deceased donor (DDKT) recipients.
RESULTS: Our study cohort includes 4987 pediatric DDKTs, 3447 pediatric non-KPD LDKTs, and 258 pediatric KPD transplants. Fewer centers conducted at least one pediatric KPD procedure compared to those that conducted at least one pediatric LDKT or DDKT procedure (67, 136, and 155 centers, respectively). Five centers performed 31% of the pediatric KPD transplants. After adjustment, there were no differences in graft failure or mortality comparing KPD recipients to non-KPD LDKT, LDKT, or DDKT recipients.
CONCLUSIONS: We did not observe differences in transplant outcomes comparing pediatric KPD recipients to controls. Considering these results, KPD may be underutilized for pediatric recipients. Pediatric KT centers should consider including KPD in KT candidate education. Further research will be necessary to develop tools that could aid clinicians and families considering the time horizon for future KT procedures, candidate disease and histocompatibility characteristics, and other factors including logistics and donor protections.
METHODS: We describe the characteristics and outcomes of pediatric KPD recipients with comparison to pediatric non-KPD living donor kidney transplants (LDKT), pediatric LDKT recipients, and pediatric deceased donor (DDKT) recipients.
RESULTS: Our study cohort includes 4987 pediatric DDKTs, 3447 pediatric non-KPD LDKTs, and 258 pediatric KPD transplants. Fewer centers conducted at least one pediatric KPD procedure compared to those that conducted at least one pediatric LDKT or DDKT procedure (67, 136, and 155 centers, respectively). Five centers performed 31% of the pediatric KPD transplants. After adjustment, there were no differences in graft failure or mortality comparing KPD recipients to non-KPD LDKT, LDKT, or DDKT recipients.
CONCLUSIONS: We did not observe differences in transplant outcomes comparing pediatric KPD recipients to controls. Considering these results, KPD may be underutilized for pediatric recipients. Pediatric KT centers should consider including KPD in KT candidate education. Further research will be necessary to develop tools that could aid clinicians and families considering the time horizon for future KT procedures, candidate disease and histocompatibility characteristics, and other factors including logistics and donor protections.
摘要：
背景：儿科（年龄<18岁）肾移植（KT）候选人面临越来越复杂的选择。2014年的肾脏分配系统使儿科接受者的等待时间几乎翻了一番。给定更长的等待时间和优化兼容性的新方法，更多的儿科候选人可能会考虑肾脏配对捐赠(KPD).受这种转变和KPD实践创新的潜在影响的激励，我们研究了2008年至2021年美国儿童KPD手术.
方法：我们描述了儿童KPD受者的特征和结果，与儿童非KPD活体肾移植（LDKT）相比，小儿LDKT接受者，和儿科死亡供体（DDKT）接受者。
结果：我们的研究队列包括4987名儿科DDKT，3447儿科非KPDLDKTs,和258例小儿KPD移植。与进行至少一种小儿LDKT或DDKT手术的中心相比，进行至少一种小儿KPD手术的中心较少（67、136和155个中心，分别)。五个中心进行了31％的小儿KPD移植。调整后,KPD受者与非KPDLDKT相比，移植物衰竭或死亡率没有差异，LDKT,或DDKT收件人。
结论：我们没有观察到儿童KPD受者与对照组移植结果的差异。考虑到这些结果,儿童接受者可能未充分利用KPD。儿科KT中心应考虑将KPD纳入KT候选教育。进一步的研究将是必要的开发工具，可以帮助临床医生和家庭考虑未来的KT程序的时间范围，候选疾病和组织相容性特征，以及其他因素，包括后勤和捐助者保护。
方法：我们描述了儿童KPD受者的特征和结果，与儿童非KPD活体肾移植（LDKT）相比，小儿LDKT接受者，和儿科死亡供体（DDKT）接受者。
结果：我们的研究队列包括4987名儿科DDKT，3447儿科非KPDLDKTs,和258例小儿KPD移植。与进行至少一种小儿LDKT或DDKT手术的中心相比，进行至少一种小儿KPD手术的中心较少（67、136和155个中心，分别)。五个中心进行了31％的小儿KPD移植。调整后,KPD受者与非KPDLDKT相比，移植物衰竭或死亡率没有差异，LDKT,或DDKT收件人。
结论：我们没有观察到儿童KPD受者与对照组移植结果的差异。考虑到这些结果,儿童接受者可能未充分利用KPD。儿科KT中心应考虑将KPD纳入KT候选教育。进一步的研究将是必要的开发工具，可以帮助临床医生和家庭考虑未来的KT程序的时间范围，候选疾病和组织相容性特征，以及其他因素，包括后勤和捐助者保护。
