Living unrelated renal transplantation: a good match for the pediatric candidate?

J Pediatr Surg. 2013 Jun;48(6):1277-82. doi: 10.1016/j.jpedsurg.2013.03.023.


Background/purpose: Living donor kidney transplantation is encouraged for children with end-stage renal disease given the superior survival of living donor grafts, but pediatric candidates are also given preference for kidneys from younger deceased donors.

Methods: Death-censored graft survival of pediatric kidney-only transplants performed in the U.S. between 1987-2012 was compared across living related (LRRT) (n=7741), living unrelated (LURT) (n=618), and deceased donor renal transplants (DDRT) (n=8945) using Kaplan-Meier analysis, multivariable Cox proportional hazards models, and matched controls analysis.

Results: As expected, HLA mismatch was greater among LURT compared to LRRT (p<0.001). Unadjusted graft survival was lower, particularly long-term, for LURT compared to LRRT (p=0.009). However, LURT graft survival was still superior to DDRT graft survival, even when compared only to deceased donors under age 35 (p=0.002). The difference in graft survival between LURT and LRRT was not seen when adjusting for HLA mismatch, year of transplantation, and donor and recipient characteristics using a Cox model (aHR=1.04, 95% CI: 0.87-1.24, p=0.7) or matched controls (HR=1.02, 95% CI: 0.82-1.27, p=0.9).

Conclusion: Survival of LURT grafts is superior to grafts from younger deceased donors and equivalent to LRRT grafts when adjusting for other factors, most notably differences in HLA mismatch.

Keywords: Donor type; Graft survival; Pediatric kidney transplantation.

Publication types

  • Comparative Study
  • Evaluation Study

MeSH terms

  • Adolescent
  • Age Factors
  • Child
  • Child, Preschool
  • Female
  • Follow-Up Studies
  • Graft Survival*
  • Humans
  • Infant
  • Infant, Newborn
  • Kidney Failure, Chronic / surgery*
  • Kidney Transplantation / methods*
  • Living Donors*
  • Male
  • Registries
  • Survival Analysis
  • Treatment Outcome
  • United States
  • Unrelated Donors*