title: Outcomes and discard of kidneys from pediatric donors after cardiac death.
abstract: BACKGROUND
  Kidney transplants from pediatric donors after cardiac death (PDCD) have quadrupled in the past 9 years, but little data exist on outcomes using these donors. We hypothesized that pediatric organs might be more sensitive to the pathophysiology of cardiac death.
  
  
  METHODS
  We evaluated outcomes and rates of discard of more than 12,000 pediatric kidneys recovered between 2000 and 2009. We compared short- and long-term graft function among adult and pediatric recipients of PDCD kidneys compared with recipients of pediatric kidneys from donors after brain death (PDBD).
  
  
  RESULTS
  Overall, 6.3% of pediatric kidneys recovered were PDCD and 93.7% were PDBD. Discard rates were higher for PDCD kidneys (adjusted odds ratio=1.69, 95% confidence interval [CI]=1.31-2.18, P<0.001). Delayed graft function (DGF) was twice as common in recipients of PDCD grafts compared with PDBD (26.2% vs. 13.0%, P<0.001); however, among pediatric recipients, DGF rates were half of those observed in adults, and a statistically significant difference in DGF could not be detected between PDBD and PDCD grafts (6.9% vs. 4.9%, P=0.6). Among all recipients, PDCD kidneys had a greater risk of graft loss compared with PDBD kidneys (adjusted hazard ratio=1.32, 95% CI=1.06-1.65, P=0.01), although among pediatric recipients this increased risk was not statistically significant (adjusted hazard ratio=2.01, 95% CI=0.89-4.54, P=0.1).
  
  
  CONCLUSIONS
  The differences in outcomes between adult recipients of PDCD and PDBD kidneys, and the attenuation of these differences among pediatric recipients, should be weighed against risks of prolonged waitlist time in recipients being considered for these grafts.
authors.affiliation: Division of Transplant Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.
authors.forename: Nabil N
authors.initials: NN
authors.lastname: Dagher
authors.forename: Bonnie E
authors.initials: BE
authors.lastname: Lonze
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Singer
authors.forename: Christopher E
authors.initials: CE
authors.lastname: Simpkins
authors.forename: Niraj M
authors.initials: NM
authors.lastname: Desai
authors.forename: Robert A
authors.initials: RA
authors.lastname: Montgomery
authors.forename: Dorry L
authors.initials: DL
authors.lastname: Segev
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D003643:Death; D005260:Female; D006085:Graft Survival; D006801:Humans; D007223:Infant; D016030:Kidney Transplantation / Q000401:mortality; D008297:Male; D014019:Tissue Donors; D016896:Treatment Outcome