The UK kidney donor risk index poorly predicts long-term transplant survival in paediatric kidney transplant recipients

BackgroundThe UK kidney offering scheme introduced a kidney donor risk index (UK-KDRI) to improve the utility of deceased-donor kidney allocations. The UK-KDRI was derived using adult donor and recipient data. We assessed this in a paediatric cohort from the UK transplant registry.MethodsWe performe...

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Main Authors: Jon Jin Kim, Rebecca M. K. Curtis, Ben Reynolds, Stephen D. Marks, Martin Drage, Vasilis Kosmoliaptsis, Jan Dudley, Alun Williams
Format: Article
Language:English
Published: Frontiers Media S.A. 2023-06-01
Series:Frontiers in Immunology
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Online Access:https://www.frontiersin.org/articles/10.3389/fimmu.2023.1207145/full
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author Jon Jin Kim
Jon Jin Kim
Rebecca M. K. Curtis
Ben Reynolds
Stephen D. Marks
Stephen D. Marks
Martin Drage
Vasilis Kosmoliaptsis
Vasilis Kosmoliaptsis
Jan Dudley
Alun Williams
author_facet Jon Jin Kim
Jon Jin Kim
Rebecca M. K. Curtis
Ben Reynolds
Stephen D. Marks
Stephen D. Marks
Martin Drage
Vasilis Kosmoliaptsis
Vasilis Kosmoliaptsis
Jan Dudley
Alun Williams
author_sort Jon Jin Kim
collection DOAJ
description BackgroundThe UK kidney offering scheme introduced a kidney donor risk index (UK-KDRI) to improve the utility of deceased-donor kidney allocations. The UK-KDRI was derived using adult donor and recipient data. We assessed this in a paediatric cohort from the UK transplant registry.MethodsWe performed Cox survival analysis on first kidney-only deceased brain-dead transplants in paediatric (<18 years) recipients from 2000-2014. The primary outcome was death-censored allograft survival >30 days post-transplant. The main study variable was UK-KDRI derived from seven donor risk-factors, categorised into four groups (D1-low risk, D2, D3 and D4-highest risk). Follow-up ended on 31-December-2021.Results319/908 patients experienced transplant loss with rejection as the main cause (55%). The majority of paediatric patients received donors from D1 donors (64%). There was an increase in D2-4 donors during the study period, whilst the level of HLA mismatching improved. The KDRI was not associated with allograft failure. In multi-variate analysis, increasing recipient age [adjusted HR and 95%CI: 1.05(1.03-1.08) per-year, p<0.001], recipient minority ethnic group [1.28(1.01-1.63), p<0.05), dialysis before transplant [1.38(1.04-1.81), p<0.005], donor height [0.99 (0.98-1.00) per centimetre, p<0.05] and level of HLA mismatch [Level 3: 1.92(1.19-3.11); Level 4: 2.40(1.26-4.58) versus Level 1, p<0.01] were associated with worse outcomes. Patients with Level 1 and 2 HLA mismatches (0 DR +0/1 B mismatch) had median graft survival >17 years regardless of UK-KDRI groups. Increasing donor age was marginally associated with worse allograft survival [1.01 (1.00-1.01) per year, p=0.05].SummaryAdult donor risk scores were not associated with long-term allograft survival in paediatric patients. The level of HLA mismatch had the most profound effect on survival. Risk models based on adult data alone may not have the same validity for paediatric patients and therefore all age-groups should be included in future risk prediction models.
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spelling doaj.art-c2e900b895624c2f927cf030c9db0b0e2023-06-02T05:49:37ZengFrontiers Media S.A.Frontiers in Immunology1664-32242023-06-011410.3389/fimmu.2023.12071451207145The UK kidney donor risk index poorly predicts long-term transplant survival in paediatric kidney transplant recipientsJon Jin Kim0Jon Jin Kim1Rebecca M. K. Curtis2Ben Reynolds3Stephen D. Marks4Stephen D. Marks5Martin Drage6Vasilis Kosmoliaptsis7Vasilis Kosmoliaptsis8Jan Dudley9Alun Williams10Department of Surgery, University of Cambridge, Cambridge, United KingdomDepartment of Paediatric Nephrology, Nottingham University Hospitals, Nottingham, United KingdomStatistics and Clinical Research, NHS Blood and Transplant, Bristol, United KingdomDepartment of Paediatric Nephrology, Royal Hospital for Children, Glasgow, United KingdomDepartment of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United KingdomNIHR Great Ormond Street Hospital Biomedical Research Centre, University College London Great Ormond Street Institute of Child Health, London, United KingdomDepartment of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United KingdomDepartment of Surgery, University of Cambridge, Cambridge, United KingdomNIHR Blood and Transplant Research Unit in Organ Donation and Transplantation, University of Cambridge, Cambridge, United KingdomDepartment of Paediatric Nephrology, Bristol Children’s Hospital, Bristol, United KingdomDepartment of Paediatric Nephrology, Nottingham University Hospitals, Nottingham, United KingdomBackgroundThe UK kidney offering scheme introduced a kidney donor risk index (UK-KDRI) to improve the utility of deceased-donor kidney allocations. The UK-KDRI was derived using adult donor and recipient data. We assessed this in a paediatric cohort from the UK transplant registry.MethodsWe performed Cox survival analysis on first kidney-only deceased brain-dead transplants in paediatric (<18 years) recipients from 2000-2014. The primary outcome was death-censored allograft survival >30 days post-transplant. The main study variable was UK-KDRI derived from seven donor risk-factors, categorised into four groups (D1-low risk, D2, D3 and D4-highest risk). Follow-up ended on 31-December-2021.Results319/908 patients experienced transplant loss with rejection as the main cause (55%). The majority of paediatric patients received donors from D1 donors (64%). There was an increase in D2-4 donors during the study period, whilst the level of HLA mismatching improved. The KDRI was not associated with allograft failure. In multi-variate analysis, increasing recipient age [adjusted HR and 95%CI: 1.05(1.03-1.08) per-year, p<0.001], recipient minority ethnic group [1.28(1.01-1.63), p<0.05), dialysis before transplant [1.38(1.04-1.81), p<0.005], donor height [0.99 (0.98-1.00) per centimetre, p<0.05] and level of HLA mismatch [Level 3: 1.92(1.19-3.11); Level 4: 2.40(1.26-4.58) versus Level 1, p<0.01] were associated with worse outcomes. Patients with Level 1 and 2 HLA mismatches (0 DR +0/1 B mismatch) had median graft survival >17 years regardless of UK-KDRI groups. Increasing donor age was marginally associated with worse allograft survival [1.01 (1.00-1.01) per year, p=0.05].SummaryAdult donor risk scores were not associated with long-term allograft survival in paediatric patients. The level of HLA mismatch had the most profound effect on survival. Risk models based on adult data alone may not have the same validity for paediatric patients and therefore all age-groups should be included in future risk prediction models.https://www.frontiersin.org/articles/10.3389/fimmu.2023.1207145/fullpaediatric kidney transplantationkidney allocationdonor qualitydonor agedonor risk indexHLA mismatching
spellingShingle Jon Jin Kim
Jon Jin Kim
Rebecca M. K. Curtis
Ben Reynolds
Stephen D. Marks
Stephen D. Marks
Martin Drage
Vasilis Kosmoliaptsis
Vasilis Kosmoliaptsis
Jan Dudley
Alun Williams
The UK kidney donor risk index poorly predicts long-term transplant survival in paediatric kidney transplant recipients
Frontiers in Immunology
paediatric kidney transplantation
kidney allocation
donor quality
donor age
donor risk index
HLA mismatching
title The UK kidney donor risk index poorly predicts long-term transplant survival in paediatric kidney transplant recipients
title_full The UK kidney donor risk index poorly predicts long-term transplant survival in paediatric kidney transplant recipients
title_fullStr The UK kidney donor risk index poorly predicts long-term transplant survival in paediatric kidney transplant recipients
title_full_unstemmed The UK kidney donor risk index poorly predicts long-term transplant survival in paediatric kidney transplant recipients
title_short The UK kidney donor risk index poorly predicts long-term transplant survival in paediatric kidney transplant recipients
title_sort uk kidney donor risk index poorly predicts long term transplant survival in paediatric kidney transplant recipients
topic paediatric kidney transplantation
kidney allocation
donor quality
donor age
donor risk index
HLA mismatching
url https://www.frontiersin.org/articles/10.3389/fimmu.2023.1207145/full
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