Pediatric liver and kidney transplantation with allografts from DCD donors: A review of UNOS data.
BACKGROUND
Donation after cardiac death (DCD) is recognized as an important source of allografts to bridge the growing disequilibrium between the number of donors and recipients. Current transplant experience with DCD organs has focused on the adult recipient population, however little is known about the pediatric recipient experience. While there is increasing acceptance of these grafts in adults, transplant centers appear reluctant to use these grafts in the pediatric population.


METHODS
We reviewed the United Network for Organ Sharing database from 1995-2005 to determine the national experience with pediatric recipients of DCD organs.


RESULTS
Among 4026 renal transplants performed in children 18 years and younger, 26 (0.6%) received a renal allograft from a DCD donor. Ten (38.5%) received kidney allografts from pediatric donors (age < or = 18) and 16 (61.5%) from adult donors (age > 18 years). Graft survival at one and five years was 82.5%, 74.3% for kidneys from DCD donors compared to 89.6%, 64.8% from brain dead donors (DBD) (P = 0.7). Among 4991 liver transplants, 19 (0.4%) were from DCD donors. Sixteen patients (84.2%) received livers from pediatric donors and three (15.8%) from adult donors. Graft survival at one and five years was 89.2%, 79.3% for livers from DCD, compared to 75.6%, 65.8% for DBD (P = 0.3).


CONCLUSIONS
The use of DCD donors in the pediatric population is very limited; however graft survival is comparable to DBD grafts. Although pediatric centers may have been reluctant to utilize this donor source, this limited experience demonstrates that the select use of DCD organs can produce acceptable and durable graft survival in the pediatric population.
Abt
Peter
P
Department of Surgery, Solid Organ Transplantation and Hepatobiliary Surgery Division, University of Rochester Medical Center, Rochester, NY 14642-8410, USA. peter_abt@urmc.rochester.edu
Kashyap
Randeep
R
Orloff
Mark
M
Jain
Ashok
A
Tsoulfas
George
G
Bozorgzadeh
Adel
A
Olthoff
Kim
K
D000293:Adolescent; D002102:Cadaver; D002648:Child; D016208:Databases, Factual; D016757:Death, Sudden, Cardiac; D046148:Donor Selection; D005260:Female; D006801:Humans; D016030:Kidney Transplantation; D016031:Liver Transplantation; D008297:Male; D014019:Tissue Donors; D016896:Treatment Outcome