title: Transplantation of kidneys from paediatric DCD donors: a comparison with DBD donors.
abstract: BACKGROUND
  Although acceptable outcomes have been reported in kidney transplantation from donation after cardiac death (DCD), little is known about kidney transplantation from paediatric DCD. The objective of this study was to compare the outcome of kidney transplantation using paediatric DCD with the outcome of paediatric donation after brain death (DBD).
  
  
  METHODS
  Recipients from DCD and DBD donors <18 years of age transplanted in the Netherlands between January 1981 and July 2006 were included in this study. Ninety-one patients were transplanted with kidneys from paediatric DCD donors and 405 patients received grafts from paediatric DBD donors.
  
  
  RESULTS
  Grafts from DCD donors were associated with higher percentage of primary non-function (9 versus 2%, P < 0.01) and delayed graft function (48 versus 8%, P < 0.001) compared with DBD donor grafts. Estimated glomerular filtration rate did not differ between groups (57 ± 17 versus 58 ± 21 mL/min at 1 year and 62 ± 14 versus 57 ± 22 mL/min at 5 years, respectively). After correction for confounding variables, the risk of graft failure was higher in the DCD group [hazard ratio 2.440 (95% confidence interval (CI) 1.280-4.650; P = 0.007]. Patient survival, however, was similar between groups [hazard ratio 1.559 (95% CI 0.848-2.867; P = 0.153)].
  
  
  CONCLUSIONS
  Paediatric DCD kidneys represent a valuable source of donor kidneys that has not been fully utilized. Although transplantation of paediatric DCD kidneys is associated with a higher risk of graft failure than transplantation of paediatric DBD kidneys, results are comparable with adult donors. We therefore conclude that paediatric DCD kidneys can be safely added to the donor pool.
authors.affiliation: Department of General Surgery, Maastricht University Medical Center, Maastricht, AZ, The Netherlands. evadevrs@gmail.com
authors.forename: Eva E
authors.initials: EE
authors.lastname: de Vries
authors.forename: Pieter E R
authors.initials: PE
authors.lastname: Hoogland
authors.forename: Jentina
authors.initials: J
authors.lastname: Wind
authors.forename: Maarten G J
authors.initials: MG
authors.lastname: Snoeijs
authors.forename: Ernest L W
authors.initials: EL
authors.lastname: van Heurn
mesh_terms: D000293:Adolescent; D001926:Brain Death; D002648:Child; D002675:Child, Preschool; D003643:Death; D051799:Delayed Graft Function / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D007223:Infant; D007676:Kidney Failure, Chronic / Q000601:surgery*; D016030:Kidney Transplantation / Q000379:methods*; D008297:Male; D009426:Netherlands; D012189:Retrospective Studies; D014019:Tissue Donors; D009927:Tissue and Organ Procurement / Q000706:statistics & numerical data*; D016896:Treatment Outcome