Living related paediatric renal transplantation
| Registration of children for kidney transplantation | << Back... |
| ANNEX A | Paediatric renal transplantation |
| ANNEX B | Listing for paediatric cadaveric renal transplantation |
| ANNEX C | Pre-emptive transplantation |
| ANNEX D | Living related paediatric renal transplantation |
Tissue Typing
Audit has shown significantly better outcomes with cadaveric renal transplantation in paediatric recipients who receive 000 mismatched and favourably matched kidneys, compared with those who receive less well matched kidneys¹. Modelling has shown that if easily matchable paediatric patients (1-5 on UKT matchability score) were only listed for favourably matched kidneys there would be an increase in favourable matches to 80% with no reduction in the number of paediatric transplants performed and a trivial increase in waiting time. Avoiding the use of poorly matched grafts will reduce the number of children who become sensitised.
These data have been discussed with all paediatric transplant centres and it is recommended that:
- Paediatric recipients with a matchability score of 1-5 are listed only for 000 mismatched or favourably matched kidneys.
- A system is established for registering easily matchable children in whom a non-favourably matched kidney would be considered because of clinical urgency.
- Non-favourably matched transplants in paediatric recipients should be audited on an annual basis.
Children who are more difficult to match might benefit from a less well-matched kidney so as to avoid a long wait on the transplant list. Similarly for those who are easily matched, if they have not received a transplant after 6 to 12 months, then the matching criteria could be relaxed.
Renal Association and BTS guidelines recommend that at least 60% of paediatric grafts should be favourably matched².
Cadaveric Donors
As the use of very young donors and older adult donors is associated with a poorer outcome¹, it is recommended that only kidneys from cadaveric donors aged 5 to 50 years be used for paediatric recipients.
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¹UKT paediatric data
²Treatment of adults and children with renal failure,
3rd Edition, Renal Association, 2002
