Introduction: ABOi transplantation from living donors is a growing practice with excellent clinical outcomes. Some paediatric transplant programmes are still reluctant to offer ABOi transplantation and list children on a DD waiting list. However, there are no studies directly comparing the outcomes between pediatric ABOi living donor kidney transplants (LDKTx) and ABOc deceased donor transplants (DDKTx).
Method: Data were retrieved on all pediatric kidney transplants from 1987-2020, from the United Network for Organ Sharing. Propensity score matching was used to select a control group of ABOc transplant recipients. Long term outcomes were compared between ABOi and ABOc kidney transplants and between ABOi LDKTx and ABOc transplants DDKTx. Data were compared using chi-square test, t-test and Kaplan-Meier survival analysis.
Results: Overall, there were 70 pediatric ABOi kidney transplants in the US during the study period. There was no significant difference in allograft (p=0.42) and patient survival (p=0.58), and no difference in rates of delayed allograft function or primary allograft non-function (p=0.89, p=0.77) between ABOi and ABOc transplants. ABOi LDKTx had significantly lower rates of delayed allograft function and better long-term allograft survival than ABOc DDKTx (p<0.01, p=0.01).
Conclusion: ABOi transplantation has excellent long-term outcomes. More importantly, ABOi LDKTx lead to better long-term outcomes than ABOc DDKTx. We recommend that ABOi transplantation from a living donor should be considered prior to listing children for transplantation from a deceased donor.