Changes in Pediatric Renal Transplantation After Implementation of the Revised Deceased Donor Kidney Allocation Policy

TLDR

In October 2005, the United Network for Organ Sharing revised its kidney allocation policy to give priority to pediatric patients for kidneys from young deceased donors (<35 years). This study compares quarterly pediatric transplant statistics before and after the policy change from 2000 to 2008. The authors analyzed pre‑ and postpolicy transplant data, focusing on donor age, HLA mismatch, and donor type across the study period. After the policy, pediatric transplants from young deceased donors nearly doubled (62.8 to 133 per quarter), while transplants from older donors and living donors fell sharply, and HLA‑mismatched allografts increased.

Abstract

In October 2005, the United Network for Organ Sharing (UNOS) implemented a revised allocation policy requiring that renal allografts from young deceased donors (DDs) (<35 years old) be offered preferentially to pediatric patients (<18 years old). In this study, we compare the pre- and postpolicy quarterly pediatric transplant statistics from 2000 to 2008. The mean number of pediatric renal transplants with young DDs increased after policy implementation from 62.8 to 133 per quarter (p < 0.001), reflecting a change in the proportion of all transplants from young DDs during the study period from 0.33 to 0.63 (p < 0.001). The mean number of pediatric renal transplants from old DDs (≥35 years old) decreased from 22.4 to 2.6 per quarter (p < 0.001). The proportion of all pediatric renal transplants from living donors decreased from 0.55 to 0.35 (p < 0.001). The proportion from young DDs with five or six mismatched human leukocyte antigen (HLA) loci increased from 0.16 to 0.36 (p < 0.001) while those with 0 to 4 HLA mismatches increased from 0.18 to 0.27 (p < 0.001). Revision of UNOS policy has increased the number of pediatric renal transplants with allografts from young DDs, while increasing HLA-mismatched allografts and decreasing the number from living donors.