RESUMEN
BACKGROUND: Pediatric en bloc kidneys are considered marginal for transplantation into adults. We aimed to compare the long-term outcomes of pediatric en bloc versus living donor kidney transplantation. METHODS: A retrospective review was undertaken on pediatric en bloc and living donor kidney transplants performed at our center between 1990 and 2001. The outcomes compared between the groups included 25 year graft survival and longitudinal glomerular filtration rate. RESULTS: There were 72 pediatric en bloc and 75 living donor kidney recipients included in the analysis. Pediatric donors were 16.9 ± 11.2 months old and weighed 10.7 ± 3.8 kg with terminal serum creatinine of 0.50 ± 0.45 mg/dL. Living donors were 40.1 ± 9.4 years old and serum creatinine was 0.90 ± 0.16 mg/dL at the time of donation. En bloc kidney recipients had higher dialysis vintage (23.0 ± 29.2 months vs 14.3 ± 14.7 months; P = 0.03), and longer cold ischemia time (30.5 ± 9.8 hours vs 2.6 ± 0.9 hours, P < 0.001). Kaplan-Meier estimate revealed similar graft survival between the groups up to 27 years of follow up (log rank P = 0.78). Estimated glomerular filtration rate was significantly higher in pediatric en bloc kidney recipients from years 5 through 17 posttransplantation. CONCLUSIONS: Pediatric en bloc kidneys conferred long-term graft survival similar to living donor kidneys over a 25-year period after transplantation along with superior graft function. These findings support improved utilization of pediatric kidneys for transplantation into adults which not only helps to alleviate organ shortage but also provide excellent long-term function.
Asunto(s)
Trasplante de Riñón/métodos , Donadores Vivos , Adulto , Factores de Edad , Biomarcadores/sangre , Preescolar , Creatinina/sangre , Selección de Donante , Femenino , Estudios de Seguimiento , Tasa de Filtración Glomerular , Supervivencia de Injerto , Humanos , Lactante , Trasplante de Riñón/efectos adversos , Masculino , Pennsylvania , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo , Resultado del TratamientoRESUMEN
BACKGROUND: Induction immunosuppression decreases the risk for acute rejection and improves graft outcomes in kidney transplant recipients (KTRs). We aimed to compare the outcomes of induction with Thymoglobulin and alemtuzumab in KTRs through paired-kidney analysis. METHODS: Using Organ Procurement and Transplantation Network/United Network for Organ Sharing database from 2003 to 2013, we identified recipients of deceased donor kidneys from the same donor in such a way that 1 patient received Thymoglobulin induction and recipient of the mate kidney underwent alemtuzumab induction. All patients were discharged on maintenance immunosuppression with tacrolimus and mycophenolate mofetil with/without steroids. Outcomes were compared between the groups in an adjusted model. RESULTS: Study cohort included 1149 patients each in alemtuzumab and Thymoglobulin groups. Incidence of delayed graft function (25.8% vs 28.6%, P = 0.12), and 1-year rejection (5.7% vs 4.5%, P = 0.97) were similar for alemtuzumab versus Thymoglobulin groups. Adjusted overall graft (hazard ratio, 0.97; 95% confidence interval, 0.82-1.48; P = 0.52) and patient (hazard ratio, 0.86; 95% confidence interval, 0.69-1.05) survivals were also similar for alemtuzumab versus Thymoglobulin groups. Median hospital length of stay was significantly shorter in alemtuzumab group (4 days vs 5 days, P < 0.001). Similar findings were observed in a subgroup of high immune risk patients. There was evidence for clustering of alemtuzumab use within transplant centers which did not impact long-term outcomes. CONCLUSIONS: Depleting antibody induction therapy with alemtuzumab and Thymoglobulin appear equally effective in deceased donor KTRs maintained on tacrolimus/mycophenolate mofetil-based regimen along with steroid. Alemtuzumab induction is beneficial in reducing hospital length of stay.