Optimizing Kidney Allograft Years: Underutilization of Pediatric Donors.

Abstract

Background: The Kidney Donor Profile Index (KDPI) score drives kidney allocation in the United States for both adult and pediatric donors, despite the calculation being primarily derived from adult donor data. A KDPI of ≤20% is considered to have the longest graft survival potential and is typically prioritized for recipients who have a low Estimated Posttransplant Survival (EPTS) score. Using KDPI to assess pediatric donor quality may underestimate graft survival and result in underutilization of these kidneys for recipients with a low EPTS score.

Methods: Using Scientific Registry of Transplant Recipients data, we analyzed 5-y posttransplant death-censored graft survival of kidneys from donors aged 0-<4, 4-<8, 8-<12, and 12-<18 y compared with adult donor kidneys with a KDPI of ≤20% to adult recipients using Kaplan-Meier analysis, pairwise comparisons, and multivariate Cox proportional models.

Results: Death-censored graft survival was not significantly different for pediatric donors aged 8-<12 y (χ² = 0.8, P = 0.37) and 12-<18 y (χ² = 0.23, P = 0.63) when compared with adult donor kidneys. Five-year graft survival was 91.8%, 92.3%, and 92.4%, respectively, with a mean KDPI of 37.5% (range, 1%-85%), 16.2% (range, 0%-85%), and 10.7% (range, 0%-19%) and mean EPTS score of 42.9%, 29.9%, and 22.8%, respectively.

Conclusions: Graft survival for kidneys from donors aged 8-18 y is not inferior to that of adult donors with a KDPI of ≤20%. These data support the use of pediatric donors aged 8 y and older for those recipients who traditionally received adult donor kidneys with a KDPI of ≤20%.