K. R. Jackson1, S. Zhou1, J. Ruck1, C. Holscher1, A. Massie1, A. Kernodle1, J. Glorioso1, J. Motter1, N. Desai1, D. Segev1, J. Garonzik-Wang1 1Johns Hopkins University School Of Medicine,Baltimore, MD, USA
Introduction: The new Kidney Allocation System (KAS) has resulted in fewer pediatric kidneys being allocated to pediatric deceased donor kidney transplant (pDDKT) recipients. This has prompted concerns that post-pDDKT outcomes may worsen and led to suggestions that KAS should be modified to reverse this change.
Methods: To study whether post-transplant outcomes have worsened under KAS, we used SRTR data to compare outcomes of 953 pre-KAS pDDKT (age < 18 years) recipients (12/4/2012-12/3/2014) to 934 post-KAS pDDKT recipients (12/4/2014-12/3/2016). We analyzed mortality and graft loss using Cox regression, delayed graft function (DGF) using logistic regression, and length of stay (LoS) using negative binomial regression. Multivariable models were adjusted for donor and recipient characteristics.
Results: Post-KAS recipients had longer dialysis times (median 1.26 vs. 1.07 years, p=0.02) and were more often cPRA 100% (2.0% vs. 0.1%, p=0.001). Post-KAS recipients had less graft loss than pre-KAS recipients (hazard ratio [HR]: 0.350.540.83, p=0.005, Table), but equivalent mortality (HR: 0.230.722.28, p=0.6), DGF (odds ratio [OR]: 0.931.321.87, p=0.1), and LoS (LoS ratio: 0.961.061.16, p=0.3). After adjusting for donor/recipient characteristics, there were no post-KAS differences in mortality (adjusted HR [aHR]: 0.230.933.73, p=0.9), DGF (adjusted OR: 0.931.372.03, p=0.1), or LoS (adjusted LoS ratio: 0.931.041.16, p=0.5). However, post-KAS pDDKT recipients still had less graft loss (aHR: 0.390.610.96, p=0.03).
Conclusion: Despite a decrease in pediatric donor kidneys being allocated to pDDKT recipients, there is no evidence that post-transplant outcomes have worsened for pDDKT recipients under KAS. Therefore, any KAS modification discussions should consider this context.
