Very small pediatric donor kidney transplantation in pediatric recipients
Kidneys from very small pediatric donors (age
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| Veröffentlicht in: | Pediatric transplantation 2017-08, Vol.21 (5), p.n/a |
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| container_title | Pediatric transplantation |
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| creator | Yaffe, H. C. Friedmann, P. Kayler, L. K. |
| description | Kidneys from very small pediatric donors (age |
| doi_str_mv | 10.1111/petr.12924 |
| format | Article |
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C. ; Friedmann, P. ; Kayler, L. K.</creator><creatorcontrib>Yaffe, H. C. ; Friedmann, P. ; Kayler, L. K.</creatorcontrib><description>Kidneys from very small pediatric donors (age <5 years, weight <21 kg) may be a means to increase the donor pool for pediatric recipients. Transplantation of small pediatric kidneys is more commonly performed in adult recipients due to the increased risks of technical complications, thrombosis, and early graft failure. While these risks are abrogated in adult recipients by limiting the donor weight to ≥10 kg and using the EB technique, it is unknown whether pediatric recipients achieve comparable results. US national data were assessed for all first‐time, deceased‐donor, kidney‐only pediatric recipients, 1/1996‐10/2013, who received very small pediatric donor grafts or grafts from ideal adult donors. We identified 57 pediatric EB, 110 pediatric SK, and 2350 adult transplants. The primary outcome was 3‐year all‐cause graft survival. Kaplan‐Meier curves showed worse outcomes for pediatric grafts compared to adult ideal grafts (P=.042). On multivariate analysis, pediatric recipients of SK grafts had significantly higher HRs (aHR 2.01, 95% CI 1.34‐3.00) and pediatric recipients of EB grafts had somewhat higher non‐significant HRs (1.57; 95% CI 0.88‐2.79) for graft survival. These results suggest cautionary use of very small pediatric donors as a source to expand the donor pool for pediatric candidates.</description><identifier>ISSN: 1397-3142</identifier><identifier>EISSN: 1399-3046</identifier><identifier>DOI: 10.1111/petr.12924</identifier><identifier>PMID: 28397368</identifier><language>eng</language><publisher>Denmark: Wiley Subscription Services, Inc</publisher><subject>Adolescent ; Adult ; Age ; Age Factors ; Body Weight ; Child ; Child, Preschool ; Donor Selection - methods ; Donors ; Female ; Follow-Up Studies ; Graft rejection ; Graft Survival ; Grafts ; Humans ; Infant ; Infant, Newborn ; Kaplan-Meier Estimate ; Kidney transplantation ; Kidney Transplantation - methods ; Kidney transplants ; Kidneys ; Male ; Multivariate analysis ; Outcome Assessment (Health Care) ; Pediatrics ; renal transplant ; small pediatric kidneys ; Survival ; Thrombosis ; Transplantation ; Transplants & implants ; Young Adult</subject><ispartof>Pediatric transplantation, 2017-08, Vol.21 (5), p.n/a</ispartof><rights>2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd</rights><rights>2017 John Wiley & Sons A/S. 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C.</creatorcontrib><creatorcontrib>Friedmann, P.</creatorcontrib><creatorcontrib>Kayler, L. K.</creatorcontrib><title>Very small pediatric donor kidney transplantation in pediatric recipients</title><title>Pediatric transplantation</title><addtitle>Pediatr Transplant</addtitle><description>Kidneys from very small pediatric donors (age <5 years, weight <21 kg) may be a means to increase the donor pool for pediatric recipients. Transplantation of small pediatric kidneys is more commonly performed in adult recipients due to the increased risks of technical complications, thrombosis, and early graft failure. While these risks are abrogated in adult recipients by limiting the donor weight to ≥10 kg and using the EB technique, it is unknown whether pediatric recipients achieve comparable results. US national data were assessed for all first‐time, deceased‐donor, kidney‐only pediatric recipients, 1/1996‐10/2013, who received very small pediatric donor grafts or grafts from ideal adult donors. We identified 57 pediatric EB, 110 pediatric SK, and 2350 adult transplants. The primary outcome was 3‐year all‐cause graft survival. Kaplan‐Meier curves showed worse outcomes for pediatric grafts compared to adult ideal grafts (P=.042). On multivariate analysis, pediatric recipients of SK grafts had significantly higher HRs (aHR 2.01, 95% CI 1.34‐3.00) and pediatric recipients of EB grafts had somewhat higher non‐significant HRs (1.57; 95% CI 0.88‐2.79) for graft survival. These results suggest cautionary use of very small pediatric donors as a source to expand the donor pool for pediatric candidates.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Age</subject><subject>Age Factors</subject><subject>Body Weight</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Donor Selection - methods</subject><subject>Donors</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Graft rejection</subject><subject>Graft Survival</subject><subject>Grafts</subject><subject>Humans</subject><subject>Infant</subject><subject>Infant, Newborn</subject><subject>Kaplan-Meier Estimate</subject><subject>Kidney transplantation</subject><subject>Kidney Transplantation - methods</subject><subject>Kidney transplants</subject><subject>Kidneys</subject><subject>Male</subject><subject>Multivariate analysis</subject><subject>Outcome Assessment (Health Care)</subject><subject>Pediatrics</subject><subject>renal transplant</subject><subject>small pediatric kidneys</subject><subject>Survival</subject><subject>Thrombosis</subject><subject>Transplantation</subject><subject>Transplants & implants</subject><subject>Young Adult</subject><issn>1397-3142</issn><issn>1399-3046</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp90EFLwzAUB_AgipvTix9ACl5E6OxL06Y9ypg6EBSZXkOWvEJm19akRfrtzdYp4sF3yYP8-PP4E3IO0RT83DTY2inQnLIDMoY4z8M4YunhbudhDIyOyIlz6yiClGXsmIxo5n_iNBuTxRvaPnAbWZZBg9rI1hoV6LqqbfBudIV90FpZuaaUVStbU1eBqX5Ji8o0BqvWnZKjQpYOz_bvhLzezZezh_Dx6X4xu30MVZxwFmoJkaaQQF6sVAZSFSxRmtNYKomFWnFOuUrzhMVpgTrTaZJzzBlVgMorGk_I1ZDb2PqjQ9eKjXEKS38g1p0TkGUp9_EUPL38Q9d1Zyt_nYDcu4gmwL26HpSytXMWC9FYs5G2FxCJbcFiW7DYFezxxT6yW21Q_9DvRj2AAXyaEvt_osTzfPkyhH4BjKKGWA</recordid><startdate>201708</startdate><enddate>201708</enddate><creator>Yaffe, H. C.</creator><creator>Friedmann, P.</creator><creator>Kayler, L. K.</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>H94</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-5555-1585</orcidid></search><sort><creationdate>201708</creationdate><title>Very small pediatric donor kidney transplantation in pediatric recipients</title><author>Yaffe, H. C. ; Friedmann, P. ; Kayler, L. K.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3574-da10d21519fbc81acf45cd723acaefcb7727c695436fed8d6597e942c1ec72323</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Age</topic><topic>Age Factors</topic><topic>Body Weight</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Donor Selection - methods</topic><topic>Donors</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Graft rejection</topic><topic>Graft Survival</topic><topic>Grafts</topic><topic>Humans</topic><topic>Infant</topic><topic>Infant, Newborn</topic><topic>Kaplan-Meier Estimate</topic><topic>Kidney transplantation</topic><topic>Kidney Transplantation - methods</topic><topic>Kidney transplants</topic><topic>Kidneys</topic><topic>Male</topic><topic>Multivariate analysis</topic><topic>Outcome Assessment (Health Care)</topic><topic>Pediatrics</topic><topic>renal transplant</topic><topic>small pediatric kidneys</topic><topic>Survival</topic><topic>Thrombosis</topic><topic>Transplantation</topic><topic>Transplants & implants</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Yaffe, H. C.</creatorcontrib><creatorcontrib>Friedmann, P.</creatorcontrib><creatorcontrib>Kayler, L. K.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Pediatric transplantation</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Yaffe, H. C.</au><au>Friedmann, P.</au><au>Kayler, L. K.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Very small pediatric donor kidney transplantation in pediatric recipients</atitle><jtitle>Pediatric transplantation</jtitle><addtitle>Pediatr Transplant</addtitle><date>2017-08</date><risdate>2017</risdate><volume>21</volume><issue>5</issue><epage>n/a</epage><issn>1397-3142</issn><eissn>1399-3046</eissn><abstract>Kidneys from very small pediatric donors (age <5 years, weight <21 kg) may be a means to increase the donor pool for pediatric recipients. Transplantation of small pediatric kidneys is more commonly performed in adult recipients due to the increased risks of technical complications, thrombosis, and early graft failure. While these risks are abrogated in adult recipients by limiting the donor weight to ≥10 kg and using the EB technique, it is unknown whether pediatric recipients achieve comparable results. US national data were assessed for all first‐time, deceased‐donor, kidney‐only pediatric recipients, 1/1996‐10/2013, who received very small pediatric donor grafts or grafts from ideal adult donors. We identified 57 pediatric EB, 110 pediatric SK, and 2350 adult transplants. The primary outcome was 3‐year all‐cause graft survival. Kaplan‐Meier curves showed worse outcomes for pediatric grafts compared to adult ideal grafts (P=.042). On multivariate analysis, pediatric recipients of SK grafts had significantly higher HRs (aHR 2.01, 95% CI 1.34‐3.00) and pediatric recipients of EB grafts had somewhat higher non‐significant HRs (1.57; 95% CI 0.88‐2.79) for graft survival. These results suggest cautionary use of very small pediatric donors as a source to expand the donor pool for pediatric candidates.</abstract><cop>Denmark</cop><pub>Wiley Subscription Services, Inc</pub><pmid>28397368</pmid><doi>10.1111/petr.12924</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0002-5555-1585</orcidid></addata></record> |
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| ispartof | Pediatric transplantation, 2017-08, Vol.21 (5), p.n/a |
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| language | eng |
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| source | MEDLINE; Access via Wiley Online Library |
| subjects | Adolescent Adult Age Age Factors Body Weight Child Child, Preschool Donor Selection - methods Donors Female Follow-Up Studies Graft rejection Graft Survival Grafts Humans Infant Infant, Newborn Kaplan-Meier Estimate Kidney transplantation Kidney Transplantation - methods Kidney transplants Kidneys Male Multivariate analysis Outcome Assessment (Health Care) Pediatrics renal transplant small pediatric kidneys Survival Thrombosis Transplantation Transplants & implants Young Adult |
| title | Very small pediatric donor kidney transplantation in pediatric recipients |
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