Living-unrelated renal transplantation in children: A report of the North American Pediatric Renal Transplant Cooperative Study (NAPRTCS)

Amira Al-Uzri, E. Kenneth Sullivan, Richard N. Fine, William E. Harmon

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

The shortage of cadaver kidneys available for organ donation compared to growing demand has led to an increase in the use of living-unrelated donors (LURD) for renal transplantation (Tx). Results from trials in adults show that 1-year graft survival rates in LURD are similar to living-related donor (LRD) rates and superior to those of cadaver renal donor (CAD) transplants. We report our experience with 38 LURD transplants for children enrolled in NAPRTCS that were performed between 1987 and 1997. Ages of recipients at Tx were 0-5 years (n=8), 6-12 (n=10), and >12 years (n=20). Twenty nine were primary Tx, seven were second Tx, and two were third Tx. HLA antigen data snowed that the number of 2-antigen mismatches for each locus was 44.7% for HLA-A, 71.1% for HLA-B, and 55.3% for HLA-DR. There were 7 donor/recipient pairs with a 6-antigen mismatch, 12 pairs with a 5-antigen mismatch, while there were 6 pairs with a 3-antigen match of which 3 pairs had at least one match at each of the A, B, and DR loci. A total of 38 acute rejection episodes occurred in 25 LURD recipients. Among primary grafts the incidence of first acute rejection at 30 d post-Tx was 46% in LURD vs. 29% in LRD and 37% in CAD recipients; at 1 year post-Tx it was 76% in LURD vs. 48% in LRD and 62% in CAD recipients. Acute tubular necrosis (ATN) was reported in four or 10.5% of LURD transplants compared with 5.4% in LRD and 19.0% in CAD recipients. There were 12 LURD graft failures, due to vascular thrombosis (3), acute rejection (2), recurrence of original disease (1), infection (3), and patient death (3). Estimated primary graft survival probabilities (± SE) at 12 months post-Tx are 0.825 ± 0.071 for LURD, compared to 0.911 ± 0.006 for LRD, and 0.815 ± 0.009 for CAD. We conclude that data from this study show that LURD Tx in children have a low rate of ATN that is similar to that of LRD Tx. However, LURD Tx have a high incidence of acute rejection, and the graft survival at 12 and 24 months post-Tx is inferior to LRD Tx. There is a high frequency of graft loss due to causes other than rejection, and these may be related to adverse recipient selection criteria.

Original languageEnglish (US)
Pages (from-to)139-144
Number of pages6
JournalPediatric Transplantation
Volume2
Issue number2
StatePublished - 1998
Externally publishedYes

Fingerprint

Living Donors
Kidney Transplantation
Unrelated Donors
Pediatrics
Transplants
Kidney
Cadaver
Tissue Donors
Graft Survival
Antigens
Necrosis
Tissue and Organ Procurement
HLA-A Antigens
HLA-B Antigens
Incidence
HLA-DR Antigens
HLA Antigens

Keywords

  • Cadaver
  • Living-related
  • Living-unrelated
  • Renal transplantation

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Transplantation

Cite this

Living-unrelated renal transplantation in children : A report of the North American Pediatric Renal Transplant Cooperative Study (NAPRTCS). / Al-Uzri, Amira; Kenneth Sullivan, E.; Fine, Richard N.; Harmon, William E.

In: Pediatric Transplantation, Vol. 2, No. 2, 1998, p. 139-144.

Research output: Contribution to journalArticle

@article{d0818ce00b0d4c5395353f0f252b62f6,
title = "Living-unrelated renal transplantation in children: A report of the North American Pediatric Renal Transplant Cooperative Study (NAPRTCS)",
abstract = "The shortage of cadaver kidneys available for organ donation compared to growing demand has led to an increase in the use of living-unrelated donors (LURD) for renal transplantation (Tx). Results from trials in adults show that 1-year graft survival rates in LURD are similar to living-related donor (LRD) rates and superior to those of cadaver renal donor (CAD) transplants. We report our experience with 38 LURD transplants for children enrolled in NAPRTCS that were performed between 1987 and 1997. Ages of recipients at Tx were 0-5 years (n=8), 6-12 (n=10), and >12 years (n=20). Twenty nine were primary Tx, seven were second Tx, and two were third Tx. HLA antigen data snowed that the number of 2-antigen mismatches for each locus was 44.7{\%} for HLA-A, 71.1{\%} for HLA-B, and 55.3{\%} for HLA-DR. There were 7 donor/recipient pairs with a 6-antigen mismatch, 12 pairs with a 5-antigen mismatch, while there were 6 pairs with a 3-antigen match of which 3 pairs had at least one match at each of the A, B, and DR loci. A total of 38 acute rejection episodes occurred in 25 LURD recipients. Among primary grafts the incidence of first acute rejection at 30 d post-Tx was 46{\%} in LURD vs. 29{\%} in LRD and 37{\%} in CAD recipients; at 1 year post-Tx it was 76{\%} in LURD vs. 48{\%} in LRD and 62{\%} in CAD recipients. Acute tubular necrosis (ATN) was reported in four or 10.5{\%} of LURD transplants compared with 5.4{\%} in LRD and 19.0{\%} in CAD recipients. There were 12 LURD graft failures, due to vascular thrombosis (3), acute rejection (2), recurrence of original disease (1), infection (3), and patient death (3). Estimated primary graft survival probabilities (± SE) at 12 months post-Tx are 0.825 ± 0.071 for LURD, compared to 0.911 ± 0.006 for LRD, and 0.815 ± 0.009 for CAD. We conclude that data from this study show that LURD Tx in children have a low rate of ATN that is similar to that of LRD Tx. However, LURD Tx have a high incidence of acute rejection, and the graft survival at 12 and 24 months post-Tx is inferior to LRD Tx. There is a high frequency of graft loss due to causes other than rejection, and these may be related to adverse recipient selection criteria.",
keywords = "Cadaver, Living-related, Living-unrelated, Renal transplantation",
author = "Amira Al-Uzri and {Kenneth Sullivan}, E. and Fine, {Richard N.} and Harmon, {William E.}",
year = "1998",
language = "English (US)",
volume = "2",
pages = "139--144",
journal = "Pediatric Transplantation",
issn = "1397-3142",
publisher = "Wiley-Blackwell",
number = "2",

}

TY - JOUR

T1 - Living-unrelated renal transplantation in children

T2 - A report of the North American Pediatric Renal Transplant Cooperative Study (NAPRTCS)

AU - Al-Uzri, Amira

AU - Kenneth Sullivan, E.

AU - Fine, Richard N.

AU - Harmon, William E.

PY - 1998

Y1 - 1998

N2 - The shortage of cadaver kidneys available for organ donation compared to growing demand has led to an increase in the use of living-unrelated donors (LURD) for renal transplantation (Tx). Results from trials in adults show that 1-year graft survival rates in LURD are similar to living-related donor (LRD) rates and superior to those of cadaver renal donor (CAD) transplants. We report our experience with 38 LURD transplants for children enrolled in NAPRTCS that were performed between 1987 and 1997. Ages of recipients at Tx were 0-5 years (n=8), 6-12 (n=10), and >12 years (n=20). Twenty nine were primary Tx, seven were second Tx, and two were third Tx. HLA antigen data snowed that the number of 2-antigen mismatches for each locus was 44.7% for HLA-A, 71.1% for HLA-B, and 55.3% for HLA-DR. There were 7 donor/recipient pairs with a 6-antigen mismatch, 12 pairs with a 5-antigen mismatch, while there were 6 pairs with a 3-antigen match of which 3 pairs had at least one match at each of the A, B, and DR loci. A total of 38 acute rejection episodes occurred in 25 LURD recipients. Among primary grafts the incidence of first acute rejection at 30 d post-Tx was 46% in LURD vs. 29% in LRD and 37% in CAD recipients; at 1 year post-Tx it was 76% in LURD vs. 48% in LRD and 62% in CAD recipients. Acute tubular necrosis (ATN) was reported in four or 10.5% of LURD transplants compared with 5.4% in LRD and 19.0% in CAD recipients. There were 12 LURD graft failures, due to vascular thrombosis (3), acute rejection (2), recurrence of original disease (1), infection (3), and patient death (3). Estimated primary graft survival probabilities (± SE) at 12 months post-Tx are 0.825 ± 0.071 for LURD, compared to 0.911 ± 0.006 for LRD, and 0.815 ± 0.009 for CAD. We conclude that data from this study show that LURD Tx in children have a low rate of ATN that is similar to that of LRD Tx. However, LURD Tx have a high incidence of acute rejection, and the graft survival at 12 and 24 months post-Tx is inferior to LRD Tx. There is a high frequency of graft loss due to causes other than rejection, and these may be related to adverse recipient selection criteria.

AB - The shortage of cadaver kidneys available for organ donation compared to growing demand has led to an increase in the use of living-unrelated donors (LURD) for renal transplantation (Tx). Results from trials in adults show that 1-year graft survival rates in LURD are similar to living-related donor (LRD) rates and superior to those of cadaver renal donor (CAD) transplants. We report our experience with 38 LURD transplants for children enrolled in NAPRTCS that were performed between 1987 and 1997. Ages of recipients at Tx were 0-5 years (n=8), 6-12 (n=10), and >12 years (n=20). Twenty nine were primary Tx, seven were second Tx, and two were third Tx. HLA antigen data snowed that the number of 2-antigen mismatches for each locus was 44.7% for HLA-A, 71.1% for HLA-B, and 55.3% for HLA-DR. There were 7 donor/recipient pairs with a 6-antigen mismatch, 12 pairs with a 5-antigen mismatch, while there were 6 pairs with a 3-antigen match of which 3 pairs had at least one match at each of the A, B, and DR loci. A total of 38 acute rejection episodes occurred in 25 LURD recipients. Among primary grafts the incidence of first acute rejection at 30 d post-Tx was 46% in LURD vs. 29% in LRD and 37% in CAD recipients; at 1 year post-Tx it was 76% in LURD vs. 48% in LRD and 62% in CAD recipients. Acute tubular necrosis (ATN) was reported in four or 10.5% of LURD transplants compared with 5.4% in LRD and 19.0% in CAD recipients. There were 12 LURD graft failures, due to vascular thrombosis (3), acute rejection (2), recurrence of original disease (1), infection (3), and patient death (3). Estimated primary graft survival probabilities (± SE) at 12 months post-Tx are 0.825 ± 0.071 for LURD, compared to 0.911 ± 0.006 for LRD, and 0.815 ± 0.009 for CAD. We conclude that data from this study show that LURD Tx in children have a low rate of ATN that is similar to that of LRD Tx. However, LURD Tx have a high incidence of acute rejection, and the graft survival at 12 and 24 months post-Tx is inferior to LRD Tx. There is a high frequency of graft loss due to causes other than rejection, and these may be related to adverse recipient selection criteria.

KW - Cadaver

KW - Living-related

KW - Living-unrelated

KW - Renal transplantation

UR - http://www.scopus.com/inward/record.url?scp=0032057290&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0032057290&partnerID=8YFLogxK

M3 - Article

C2 - 10082446

AN - SCOPUS:0032057290

VL - 2

SP - 139

EP - 144

JO - Pediatric Transplantation

JF - Pediatric Transplantation

SN - 1397-3142

IS - 2

ER -