Impact of the Kidney Allocation System on Young Pediatric Recipients

Overview

Journal Clin Transplant

Specialty General Surgery

Date 2018 Feb 20

PMID 29457274

Citations 11

Authors

William Fiske Parker

Lainie Friedman Ross

J Richard Thistlethwaite Jr

Amy E Gallo

Affiliations

Soon will be listed here.

Abstract

The kidney allocation system (KAS) altered pediatric candidate prioritization. We determined KAS's impact on pediatric kidney recipients by examining delayed graft function (DGF) rates from 2010 to 2016. A propensity score-matched pediatric recipients pre- and post-KAS. A semiparametric decomposition analysis estimated the contributions of KAS-related changes in donor characteristics and dialysis time on DGF rate. The unadjusted odds of DGF were 69% higher post-KAS for young (<10 years at listing) recipients (N = 1153, P = .02) but were not significantly increased for older pediatric (10-17 years at listing) recipients (N = 2624, P = .48). Post-KAS, young recipients received significantly fewer pediatric (<18 years) donor kidneys (21% vs 32%, P < .01) and had longer median pretransplant dialysis time (603 vs 435 days, P < .01). After propensity score matching, post-KAS status increased the odds of DGF in young recipients 71% (OR 1.71, 95% CI 1.01-2.46). In decomposition analysis, 24% of the higher DGF rate post-KAS was attributable to donor characteristics and 19% to increased recipient dialysis time. In a confirmatory survival analysis, DGF was associated with a 2.2 times higher risk of graft failure (aHR2.28, 95% CI 1.46-3.54). In conclusion, KAS may lead to worse graft survival outcomes in children. Allocation changes should be considered.

Citing Articles

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Renal Function at Discharge Among Kidney Recipients Experiencing Delayed Graft Function and Its Associations With Long-term Outcomes.

Kurian S, Stewart D, Toll A, Checchi K, Case J, Marsh C Transplant Direct. 2022; 8(12):e1414.

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Plumb L, Marks S Pediatr Nephrol. 2022; 38(4):941-944.

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A modified Kidney Donor Risk Index for pediatric kidney transplant recipients.

Montgomery A, Goff C, Adeyeri B, Ferreira L, Kamepalli S, Lynn J Pediatr Nephrol. 2022; 38(4):1309-1317.

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The unfinished journey toward transplant equity: an analysis of racial/ethnic disparities for children after the implementation of the Kidney Allocation System in 2014.

Charnaya O, Zeiser L, Yisar D, Goldberg A, Segev D, Massie A Pediatr Nephrol. 2022; 38(4):1275-1289.

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