Optimizing Outcomes in Pediatric Renal Transplantation Through the Australian Paired Kidney Exchange Program.
Kidney paired donation (KPD) programs offer the opportunity to enable living kidney donation when immunological and other barriers prevent safe directed donation. Children are likely to require multiple transplants during their lifetime; therefore, high-level histocompatibility and organ quality matching are key priorities. Details are given for a cohort of seven pediatric renal transplantations performed through the Australian Kidney Exchange (AKX), including barriers to alternative transplantation and outcomes after KPD. Reasons for entering the KPD program were preformed donor-specific antibodies to their registered donor in five cases, ABO mismatch, and avoidance of the risk of exposure to hepatitis B virus. Four recipients were highly sensitized. All patients received transplants with organs of lower immunological risk compared with their registered donors. HLA eplet mismatch scores were calculated for donor-recipient pairs; three patients had improved eplet mismatch load with AKX donor compared with their registered donor. All grafts are functioning, with a mean estimated glomerular filtration rate of 77 mL/min/1.73 m2(range 46-94 mL) and a follow-up range of 8-54 months, and no patient experienced clinical or histological rejection. KPD is a viable strategy to overcome many barriers to living donation for pediatric patients who have an otherwise suitable donor and provides an opportunity to minimize immunological risks.
Royal Children's Hospital, Parkville, Victoria, Australia.|Royal Melbourne Hospital, Parkville, Victoria, Australia.|University of Melbourne, Melbourne, Victoria, Australia.
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MP
Sypek
Children's Hospital at Westmead and The University of Sydney, Westmead, NSW, Australia.
S I
SI
Alexander
Victorian Transplantation and Immunogenetics Service, Melbourne, Victoria, Australia.
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Cantwell
Royal Children's Hospital, Parkville, Victoria, Australia.|University of Melbourne, Melbourne, Victoria, Australia.|Austin Health, Heidelberg, Victoria, Australia.
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FL
Ierino
Prince of Wales Hospital and The University of New South Wales, Sydney, NSW, Australia.
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Ferrari
Royal Children's Hospital, Parkville, Victoria, Australia.|University of Melbourne, Melbourne, Victoria, Australia.|Murdoch Children's Research Institute, Parkville, Victoria, Australia.
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AM
Walker
Royal Children's Hospital, Parkville, Victoria, Australia.|Royal Melbourne Hospital, Parkville, Victoria, Australia.|University of Melbourne, Melbourne, Victoria, Australia.|Murdoch Children's Research Institute, Parkville, Victoria, Australia.
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JY
Kausman
D000293:Adolescent; D000465:Algorithms; D002648:Child; D002675:Child, Preschool; D033001:Directed Tissue Donation; D046148:Donor Selection; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006650:Histocompatibility Testing; D006801:Humans; D007676:Kidney Failure, Chronic / Q000601:surgery*; D016030:Kidney Transplantation / Q000379:methods*; D008297:Male; D009392:Nephrectomy; D011379:Prognosis; D012042:Registries; D012307:Risk Factors; D013997:Time Factors; D009927:Tissue and Organ Procurement / Q000458:organization & administration*; D014181:Transplantation Immunology
clinical research/practice; donors and donation: paired exchange; kidney transplantation/nephrology; kidney transplantation: living donor; major histocompatibility complex (MHC); pediatrics; risk assessment/risk stratification