niaz ahmad - odt clinical - nhs blood and...

Niaz Ahmad

Warwick, September 2013

Paediatric Kidney Donation: excellent outcome, yet an under-utilized resource

A 15 year review

Syed Soulat Raza, Rajiv Dave, Abdul Hakeem, Michael Dawrant, Eric Finlay, Clare Ecuyer, Magdy Attia, Richard Baker, & Niaz Ahmad

Division of Surgery, Department of TransplantationSt James s University Hospital Leeds, UK

PAEDIATRIC DONORS

Excellent graft and patient outcome can be achieved by utilizing paediatric donor kidneys

Kidneys from donors under 5 yrs are transplanted en bloc

The referral donation and transplant rates of kidneys from paediatric donors less than 2 years of age remain low


PAEDIATRIC DONOREn bloc kidney transplant (EKT)

Recipient is mostly an adult or an adolescent paediatric patient

Paediatric donor

5 years or 15 Kg

En bloc transplant Single transplant

5 years or 15 Kg

PAEDIATRIC DONORS

Paediatric deaths (<2 years of age) in England & Wales

1429 audited deaths during 2010-2012

107 (7.5%) were referred as potential donors

9 (0.6%) resulted in donation

These do not include neonatal deaths

Remains an untapped resource for solid organ donation

Source: NHSBT, 2012


AIMS

We report the referral, donation, utilization and outcome of kidney transplantation from paediatric donors in the United kingdom over a 15 year period


METHODS

Retrospective review of paediatric kidney donation and the outcome of transplantation (Jan 1997 Dec 2011) in the United Kingdom

Data received from NHSBT were stratified according to donor age

Group A >5-18 yearsGroup B 2-5 yearsGroup C < 2 years


Identified Consented Proceeded76 67 64 CR=84%

Identified Consented Proceeded 47 31 26 CR =55%

Identified Consented Proceeded790 769 764 CR= 97%

Group A(>5-18years)

Group B(2-5years)

Group C (<2years)

Donor identification to conversion, n= 914

10,718 Potential Donors


RESULTS: UTILIZATION


RESULTS: RECIPIENT DEMOGRAPHICS


RESULTS: OUTCOME

(Log rank between groups not significant)


RESULTS: GRAFT SURVIVAL


RESULTS: PATIENT SURVIVAL


Donor less than 2 years of ageLeeds experience


Tx1 Tx2 Tx3 Tx4 Tx5 Tx6 Mean

Donor age 24m 7m 9m 5w 17m 8m 11m

Donor Gender Female Female Male Male Female Female _

DCD/DBD DCD DCD DCD DCD DCD DCD _

Recip age 15 yr 54 yr 21 yr 22 yr 41 yr 34 yr 31

Recip Gender Female Female Female Female Male Male _

Follow up-m 61 38 42 5 2 0 29m

Cr 67 50 48 57 92 727 63

GFR 82 86 117 69 78 - 86

CONCLUSION

Paediatric donor kidneys including those from donors under 2 yrs of age produce excellent graft and recipient outcomes

Donors under 2 yrs of age including neonatal donors (<1m) are rarely offered for donation and kidneys procured from these donors are often discarded

Block appears to be at all key stages of the process, i.e. referral, donation and utilization


ACKNOWLEDGMENT

Alex Hudson Kidney Advisory GroupNSHBT


Tea

Final plenary session: Outcomes; Abstract Prizes (Arts Centre Theatre)

niaz ahmad - odt clinical - nhs blood and...

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