Introduction: The shortage of kidneys from deceased donors for transplants is an ongoing concern, especially for pediatric recipients. Single kidney transplantation from pediatric donors to pediatric recipients (PTP) can maximize the number of pediatric recipients. Prior studies supported the use of adult donors with acute kidney injury (AKI) in pediatric recipients and pediatric donors with AKI in adult recipients. Thus, this study was designed to retrospectively examine whether pediatric recipients transplanted with single kidneys from AKI pediatric donors achieve comparable results to other PTP patients.
Methods: This retrospective cohort study investigated all single kidney transplantation PTP patients between 01/2012 and 08/2020 in a single specialized transplant center. AKI was defined by the KDIGO criteria. Outcomes and allograft function were compared between pediatric kidney transplant recipients from pediatric AKI or non-AKI donors. Cox proportional hazard model was used to assess the association between donor AKI and death-censored graft survival by 2 years.
Results: A total of 173 pediatric patients were included with a median follow-up time of 43 months (range, 24–117 months). Of these, 96 (55.49%) were transplanted from pediatric donors without AKI and 77 (44.51%) from pediatric donors who suffered AKI with 29 (37.66%) in Stage 1, 32 (41.56%) in Stage 2, and 16 (20.78%) in Stage 3. Two patients from the AKI group died of pulmonary infection (10 months and 15 months posttransplant, respectively). Two-year death-censored graft survival in the AKI group were 93.1% (Stage 1), 93.75% (Stage 2), and 93.75% (Stage 3), respectively, comparable to the results in the non-AKI group (92.71%, P = 0.876). Rejection (60%) was the leading cause of graft loss followed by vascular thrombosis (15%) and recurrent disease (10%). No significant difference was found between the two groups in the incidence of delayed graft function, and rejection (P = 0.142, 0.319, respectively). All groups demonstrated satisfactory longitudinal graft function, eGFR at 2 years posttransplant was 90.66±30.04, 91.05±25.55mL/min/1.73m² for AKI and non-AKI groups, respectively (P = 0.935). In the multivariable Cox proportional hazard analysis, donor AKI was not associated with two-year graft loss (adjusted hazard ratio 0.76, 95% confidence interval 0.11-5.14, P = 0.779) compared with the non-AKI group.
Conclusion: Single kidneys from AKI pediatric donors did not seem to influence death-censored graft survival and graft function by 2 years in pediatric recipients.