Transfusion medicine

The researches find that the Inadvertently transmit blood-borne viruses to organ recipients through transplant. Rates of IRD kidney transplants in children and the associated outcomes are unknown. Therefore They used the Scientific Registry of Transplant Recipients to identify pediatric deceased donor kidney transplants ;that are perform in the United States between January 1, 2005 and December 31, 2015.

kidney transplants in children

They used the Cox regression analysis to compare patient and graft survival between IRD and non-IRD recipients; and a sequential Cox approach to evaluate survival benefit after IRD transplants compared with remaining on the waitlist and never accepting an IRD kidney. They study 328 recipients with and 4850 without IRD transplants. The annual IRD transplant rates ranged from 3.4% to 13.2%. IRDs were more likely to be male (P = .04), black (P < .001); and die from head trauma (P = .006). IRD recipients had higher mean cPRA (0.085 vs 0.065, P = .02).

After multivariate adjustment, patient survival after IRD transplants is significantly higher compared with remaining on the waitlist (adjusted hazard ratio [aHR]: 0.48, 95% CI: 0.26-0.88, P = .018); however, patient (aHR: 0.93, 95% CI: 0.54-1.59, P = .79) and graft survival (aHR: 0.89, 95% CI: 0.70-1.13, P = .32) are similar between IRD and non-IRD recipients. They recommend that IRDs be consider for transplant in children.

New pediatric candidates

Kidney transplant is the treatment of choice for end-stage renal disease (ESRD); however, access to transplant is limit by a severe organ shortage. In 2016, 95 000 patients were active on the waitlist for a kidney transplant; however, only 13 501 patients received a deceased donor kidney. In the same year, 917 new pediatric candidates are add to the waitlist but only 583 received a deceased donor transplant.

Children on dialysis have six times higher mortality rates compare with children with a functioning graft, highlighting the importance of kidney transplant in this population. The gap between the organ supply and demand is enormous and underscores the necessity to expand the existing decease donor pool. A recent decline in living donation for pediatric recipients further emphasizes the urgency to increase the deceased donor availability.

Deceased donor pool

In 1994, the Centers for Disease Control and Prevention (CDC) defined increased-risk donors (IRDs) in an effort to minimize transplant associated viral infection transmission. The definition of CDC IRDs is update in 2013. Under the new definition, 20% of all deceased donors fall under the category of IRDs.

These donors are at risk of transmitting newly acquired HIV, hepatitis B, and/or hepatitis C infection(s) to recipients through transplant because of the inability of enzyme-linked-immunosorbent assay (ELISA) and viral nucleic acid (NAT) test to detect window period (interval between infection and detection) infections. IRDs carry a low (<1%) but non-zero risk of infection transmission. Despite the severe organ shortage, 20% of kidneys are discarded annually. Discarded kidneys frequently come from expanded criteria donors or donation after cardiac death.