D LEE1,2, N COOK1, J WHITLAM1, MA ROBERTS2, AM WALKER3, F IERINO4, J KAUSMAN3
1Department of Nephrology, Austin Health, Heidelberg, VIC; 2Department of Renal Medicine, Eastern Health, Box Hill, VIC; 3Department of Nephrology, Royal Children’s Hospital, Parkville, VIC; 4Department of Nephrology, St Vincent’s Hospital Melbourne, Fitzroy, VIC
Aims: To determine whether younger LKDs with higher end stage kidney disease (ESKD) risk were more often accepted as donors for paediatric versus adult kidney transplant recipients (KTRs)
Background: Living kidney donors (LKDs) to children have a high motivation to donate due to clear neurocognitive, growth, psychosocial, cardiovascular and survival benefits for paediatric KTRs compared to dialysis.
Methods: ANZDATA registry data of LKDs were used to estimate baseline ESKD risk without donation using a risk calculator (Grams ME et al NEJM 2016) for paediatric versus adult KTRs (2009-2014). Only 50 of 168 and 425 of 1835 LKDs for paediatric and adult KTRs respectively were included for analysis due to the unavailability of urine albumin/creatinine ratios.
Results: Compared with adult KTRs, LKDs for paediatric KTRs were significantly younger (median age 44 (IQR 36-50) vs 53 (44-60); P<0.001) and more likely to be the parents of KTRs (88% vs 23%; P<0.001). Baseline 15-year ESKD risk was lower (0.08% (0.05-0.10%) vs 0.11% (0.07-0.17%); P=0.001) whereas lifetime ESKD risk was higher (0.42% (0.33-0.64%) versus 0.37% (0.23-0.58%); P<0.05). The 90th, 95th and 98th percentiles for lifetime ESKD risk estimates in LKDs for paediatric versus adult KTRs were 1.38% vs 0.93%, 1.71% vs 1.22% and 2.12% vs 1.85% respectively. The proportion of LKDs with lifetime ESKD risk threshold >1% (12% vs 8%) and >2% (2% vs 2%) was similar.
Conclusions: LKDs for paediatric KTRs have lower 15-year but higher lifetime ESKD risk compared with adult KTRs, primarily driven by younger LKD parents. However, the absolute risk difference is minor. The likely additional benefits to the parent LKD and family of a paediatric KTR compared to remaining on dialysis merit further studies.