title: Late graft loss among pediatric recipients of DCD kidneys.
abstract: OBJECTIVE
  Kidney transplantation from donors after cardiac death (DCD) provides similar graft survival to donors after brain death (DBD) in adult recipients. However, outcomes of DCD kidneys in pediatric recipients remain unclear, primarily because of limited sample sizes.
  
  
  METHODS
  We identified 137 pediatric (<18 years old) recipients of DCD kidneys between 1994 and 2010 using Scientific Registry of Transplant Recipients data and compared outcomes with 6059 pediatric recipients of DBD kidneys during the same time period, accounting for donor, recipient, and transplant characteristics using time-varying Cox regression and matched controls. Long-term follow-up (4 years or beyond) was available for 31 DCD recipients.
  
  
  RESULTS
  Pediatric recipients of DCD kidneys experienced a significantly higher rate of delayed graft function (22.0% versus 12.3%; P = 0.001), although lower than reported delayed graft function rates of DCD grafts in adults. Although DCD and DBD graft survival was equal in the early postoperative period, graft loss among pediatric recipients of DCD kidneys exceeded their DBD counterparts starting 4 years after transplantation. This effect was statistically significant in a multivariate Cox model (hazard ratio = 2.03; 95% confidence interval, 1.21 to 3.39; P = 0.007) and matched-controls analysis (hazard ratio = 2.36; 95% confidence interval, 1.11 to 5.03; P = 0.03).
  
  
  CONCLUSIONS
  A significant increase in DCD graft loss starting 4 years after transplantation motivates a cautious approach to the use of DCD kidneys in children, in whom long-term graft survival is of utmost importance.
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.
authors.forename: Kyle J
authors.initials: KJ
authors.lastname: Van Arendonk
authors.forename: Nathan T
authors.initials: NT
authors.lastname: James
authors.forename: Jayme E
authors.initials: JE
authors.lastname: Locke
authors.forename: Robert A
authors.initials: RA
authors.lastname: Montgomery
authors.forename: Paul M
authors.initials: PM
authors.lastname: Colombani
authors.forename: Dorry L
authors.initials: DL
authors.lastname: Segev
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001926:Brain Death; D016009:Chi-Square Distribution; D002648:Child; D051799:Delayed Graft Function / Q000209:etiology; D046148:Donor Selection; D005260:Female; D006084:Graft Rejection / Q000209:etiology; D006085:Graft Survival; D006801:Humans; D053208:Kaplan-Meier Estimate; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000401:mortality; D008297:Male; D018579:Patient Selection; D016016:Proportional Hazards Models; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014019:Tissue Donors / Q000600:supply & distribution*; D009927:Tissue and Organ Procurement; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult