{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T18:59:11Z","timestamp":1782845951041,"version":"3.54.5"},"reference-count":59,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Res Protoc"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Pediatric patients with end-stage kidney disease require kidney transplants (KTs) throughout their lifetime. Long-term graft survival is dependent on multiple factors, which are broadly categorized as donor- and recipient-related factors. Advances in transplant care and changes in donor population demographics necessitate an updated analysis on donor risk factors to guide clinical decision-making.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n In this systematic review and meta-analysis, we will focus on the impact of donor factors on graft survival in pediatric KT, excluding transplants from donation after circulatory death as the latter are less common in children.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n This review encompasses studies reporting donor-related risk factors for graft survival in pediatric KT, including age, size, comorbidities, and ethnicity for living and deceased donors, as well as the cause of death and length of hospitalization for deceased donors. The literature search will use the following databases: PubMed, Scopus, Web of Science, Embase, and Cochrane. Two independent reviewers will select studies and assess their quality. Pooled estimates of relevant factors will be computed via a random-effects model using the Stata\/BE (version 19) software. Depending on data availability, subgroup analyses will be conducted based on donor type (living vs deceased). The reporting of findings will adhere to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n The search and screening for the systematic literature review are anticipated to be finished in June 2026. Data extraction, quality appraisal, and subsequent data synthesis will begin in July 2026. The review is expected to be completed by October 2026, and the study results will be published in 2027.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Our review will provide a comprehensive synthesis of the available evidence on kidney donor risk factors impacting graft survival in pediatric KT. The results of this review could provide valuable insights for clinical decisions, policy development, and ongoing efforts to improve outcomes for children with end-stage kidney disease requiring KT.<\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/71620","type":"journal-article","created":{"date-parts":[[2025,9,18]],"date-time":"2025-09-18T20:50:09Z","timestamp":1758228609000},"page":"e71620-e71620","source":"Crossref","is-referenced-by-count":0,"title":["Donor Risk Factors Affecting Graft Survival in Pediatric Kidney Transplants: Protocol for a Systematic Review and Meta-Analysis"],"prefix":"10.2196","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0387-1031","authenticated-orcid":false,"given":"Cahyani Gita","family":"Ambarsari","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4307-8513","authenticated-orcid":false,"given":"Jon Jin","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6440-1725","authenticated-orcid":false,"given":"Nur Hasnah","family":"Maamor","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6501-8565","authenticated-orcid":false,"given":"Izzah Athirah","family":"Rosli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7772-2103","authenticated-orcid":false,"given":"Nor Asiah","family":"Muhamad","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2026,2,12]]},"reference":[{"issue":"6","key":"R1","doi-asserted-by":"publisher","DOI":"10.1111\/petr.14019","article-title":"Paediatric deceased donor kidney transplant in Australia: a 30-year review-what have paediatric bonuses achieved and where to from here?","volume":"25","author":"Sypek","journal-title":"Pediatr Transplant"},{"key":"R2","doi-asserted-by":"publisher","DOI":"10.2147\/IJNRD.S304143","article-title":"High fibroblast growth factor 23 as a biomarker for severe cardiac impairment in children with chronic kidney disease: a single tertiary center study","volume":"14","author":"Palupi-Baroto","journal-title":"Int J Nephrol Renovasc Dis"},{"key":"R3","doi-asserted-by":"publisher","DOI":"10.1155\/2020\/3067453","article-title":"Low-dose maintenance intravenous iron therapy can prevent anemia in children with end-stage renal disease undergoing chronic hemodialysis","volume":"2020","author":"Ambarsari","journal-title":"Int J Nephrol"},{"issue":"1","key":"R4","doi-asserted-by":"publisher","DOI":"10.1186\/s12882-024-03771-z","article-title":"Carotid intima-media thickness, fibroblast growth factor 23, and mineral bone disorder in children with chronic kidney disease","volume":"25","author":"Palupi-Baroto","journal-title":"BMC Nephrol"},{"issue":"1","key":"R5","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1159\/000543719","article-title":"Dent disease 1 presented early with Bartter-like syndrome features and rickets: a case report","volume":"15","author":"Ambarsari","journal-title":"Case Rep Nephrol Dial"},{"issue":"1","key":"R6","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1159\/000542897","article-title":"Perioperative blood pressure management recommendations in pediatric pheochromocytoma: a 10-year narrative review","volume":"50","author":"Ambarsari","journal-title":"Kidney Blood Press Res"},{"issue":"1","key":"R7","doi-asserted-by":"publisher","DOI":"10.1186\/s12882-022-02874-9","article-title":"Distal renal tubular acidosis presenting with an acute hypokalemic paralysis in an older child with severe vesicoureteral reflux and syringomyelia: a case report","volume":"23","author":"Santoso","journal-title":"BMC Nephrol"},{"issue":"1","key":"R8","doi-asserted-by":"publisher","first-page":"75","DOI":"10.1159\/000530875","article-title":"Nephropathy in a child with severe recessive dystrophic epidermolysis bullosa treated with cyclophosphamide: a case report","volume":"13","author":"Ambarsari","journal-title":"Case Rep Nephrol Dial"},{"issue":"1","key":"R9","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1159\/000506119","article-title":"Effective management of peritoneal dialysis-associated hydrothorax in a child: a case report","volume":"10","author":"Ambarsari","journal-title":"Case Rep Nephrol Dial"},{"issue":"6","key":"R10","doi-asserted-by":"publisher","first-page":"1057","DOI":"10.1681\/ASN.0000000000000118","article-title":"Life years lost in children with kidney failure: a binational cohort study with multistate probabilities of death and life expectancy","volume":"34","author":"Wyld","journal-title":"J Am Soc Nephrol"},{"issue":"2","key":"R11","doi-asserted-by":"publisher","first-page":"245","DOI":"10.1007\/s00467-019-04362-z","article-title":"Donor considerations in pediatric kidney transplantation","volume":"36","author":"Chandar","journal-title":"Pediatr Nephrol"},{"issue":"10","key":"R12","doi-asserted-by":"publisher","first-page":"1455","DOI":"10.2215\/CJN.02310220","article-title":"Donor age, donor-recipient size mismatch, and kidney graft survival","volume":"15","author":"Lepeytre","journal-title":"Clin J Am Soc Nephrol"},{"key":"R13","doi-asserted-by":"publisher","DOI":"10.2147\/IJNRD.S248632","article-title":"Successful treatment of Hepatitis C virus infection using direct-acting antiviral agents (DAAs) in adolescents with kidney transplantation: a case series","volume":"13","author":"Ambarsari","journal-title":"Int J Nephrol Renovasc Dis"},{"issue":"1","key":"R14","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1007\/s00467-019-04393-6","article-title":"Does HLA matching matter in the modern era of renal transplantation?","volume":"36","author":"Kim","journal-title":"Pediatr Nephrol"},{"issue":"2","key":"R15","doi-asserted-by":"publisher","first-page":"491","DOI":"10.1007\/s00467-024-06487-2","article-title":"Incidence, risk factors, management strategies, and outcomes of antibody-mediated rejection in pediatric kidney transplant recipients-a multicenter analysis of the Cooperative European Paediatric Renal Transplant Initiative (CERTAIN)","volume":"40","author":"Fichtner","journal-title":"Pediatr Nephrol"},{"issue":"11","key":"R16","doi-asserted-by":"publisher","first-page":"1939","DOI":"10.1093\/ndt\/gfx259","article-title":"Effect of human leukocyte antigen mismatching on the outcomes of pediatric kidney transplantation: a systematic review and meta-analysis","volume":"32","author":"Shi","journal-title":"Nephrol Dial Transplant"},{"issue":"7","key":"R17","doi-asserted-by":"publisher","DOI":"10.1111\/petr.14369","article-title":"The kidney allocation system and pediatric transplantation at 5\u2009years","volume":"26","author":"Engen","journal-title":"Pediatr Transplant"},{"issue":"10","key":"R18","doi-asserted-by":"publisher","first-page":"1951","DOI":"10.1016\/j.ekir.2023.07.006","article-title":"Epidemiology and outcomes of children with kidney failure receiving kidney replacement therapy in Australia and New Zealand","volume":"8","author":"Ambarsari","journal-title":"Kidney Int Rep"},{"issue":"7","key":"R19","doi-asserted-by":"publisher","first-page":"2292","DOI":"10.26355\/eurrev_202204_28459","article-title":"Impact of pre-transplant dialysis modality on kidney transplant outcomes: a systematic review and meta-analysis","volume":"26","author":"Hou","journal-title":"Eur Rev Med Pharmacol Sci"},{"issue":"5","key":"R20","doi-asserted-by":"publisher","first-page":"1100","DOI":"10.1016\/j.kint.2016.07.028","article-title":"Preemptive kidney transplantation is associated with survival benefits among pediatric patients with end-stage renal disease","volume":"90","author":"Amaral","journal-title":"Kidney Int"},{"issue":"22","key":"R21","doi-asserted-by":"publisher","DOI":"10.3390\/jcm12227014","article-title":"Risk factor analysis for long-term graft survival following pediatric kidney transplantation: the importance of pretransplantation time on dialysis and donor\/recipient age difference","volume":"12","author":"Marcou","journal-title":"J Clin Med"},{"issue":"8","key":"R22","doi-asserted-by":"publisher","first-page":"1858","DOI":"10.1111\/j.1600-6143.2006.01405.x","article-title":"Kidney transplantation without prior dialysis in children: the Eurotransplant experience","volume":"6","author":"Cransberg","journal-title":"Am J Transplant"},{"issue":"7","key":"R23","doi-asserted-by":"publisher","first-page":"776","DOI":"10.1111\/petr.12569","article-title":"Pediatric deceased donor renal transplantation: an approach to decision making I. Pediatric kidney allocation in the USA: the old and the new","volume":"19","author":"Chaudhuri","journal-title":"Pediatr Transplant"},{"issue":"9","key":"R24","doi-asserted-by":"publisher","first-page":"1529","DOI":"10.1007\/s00467-015-3139-x","article-title":"Whether or not to accept a deceased donor kidney offer for a pediatric patient","volume":"30","author":"Chaudhuri","journal-title":"Pediatr Nephrol"},{"issue":"6","key":"R25","doi-asserted-by":"publisher","first-page":"588","DOI":"10.1111\/petr.12544","article-title":"Australian deceased donor kidney allocation protocols: transplant waiting and graft quality for children and adolescents","volume":"19","author":"Le Page","journal-title":"Pediatr Transplant"},{"key":"R26","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2023.1207145","article-title":"The UK kidney donor risk index poorly predicts long-term transplant survival in paediatric kidney transplant recipients","volume":"14","author":"Kim","journal-title":"Front Immunol"},{"key":"R27","unstructured":"Annual report on kidney transplantation report for 2021\/2022 2022. NHS Blood and Transplant. URL: https:\/\/nhsbtdbe.blob.core.windows.net\/umbraco-assets-corp\/27956\/kidney-annual-report-2021-22.pdf [Accessed 25-05-2025]"},{"issue":"9","key":"R28","doi-asserted-by":"publisher","first-page":"1609","DOI":"10.1007\/s00467-018-3969-4","article-title":"Renal allograft survival rates in kidneys initially declined for paediatric transplantation","volume":"33","author":"Marlais","journal-title":"Pediatr Nephrol"},{"issue":"8","key":"R29","doi-asserted-by":"publisher","DOI":"10.1111\/petr.13812","article-title":"Experience of the first 6 years of pediatric kidney transplantation in Indonesia: a multicenter retrospective study","volume":"24","author":"Ambarsari","journal-title":"Pediatr Transplant"},{"issue":"4","key":"R30","doi-asserted-by":"publisher","first-page":"1309","DOI":"10.1007\/s00467-022-05722-y","article-title":"A modified kidney donor risk index for pediatric kidney transplant recipients","volume":"38","author":"Montgomery","journal-title":"Pediatr Nephrol"},{"issue":"2","key":"R31","doi-asserted-by":"publisher","first-page":"360","DOI":"10.1097\/TP.0000000000000588","article-title":"Choosing the order of deceased donor and living donor kidney transplantation in pediatric recipients","volume":"99","author":"Van Arendonk","journal-title":"Transplantation"},{"issue":"2","key":"R32","doi-asserted-by":"publisher","first-page":"425","DOI":"10.1111\/ajt.14978","article-title":"Who can tolerate a marginal kidney? Predicting survival after deceased donor kidney transplant by donor\u2013recipient combination","volume":"19","author":"Bae","journal-title":"Am J Transplant"},{"issue":"7","key":"R33","doi-asserted-by":"publisher","first-page":"751","DOI":"10.1111\/tri.13418","article-title":"The impact of changing practice on improved outcomes of paediatric renal transplantation in the United Kingdom: a 25 years review","volume":"32","author":"Mumford","journal-title":"Transpl Int"},{"issue":"11","key":"R34","doi-asserted-by":"publisher","first-page":"2504","DOI":"10.1111\/j.1600-6143.2007.01949.x","article-title":"The evolution of nonimmune histological injury and its clinical relevance in adult-sized kidney grafts in pediatric recipients","volume":"7","author":"Naesens","journal-title":"Am J Transplant"},{"issue":"5","key":"R35","doi-asserted-by":"publisher","first-page":"336","DOI":"10.1016\/j.ijsu.2010.02.007","article-title":"Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement","volume":"8","author":"Moher","journal-title":"Int J Surg"},{"issue":"10","key":"R36","doi-asserted-by":"publisher","first-page":"e1","DOI":"10.1016\/j.jclinepi.2009.06.006","article-title":"The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration","volume":"62","author":"Liberati","journal-title":"J Clin Epidemiol"},{"key":"R37","unstructured":"Peterson J Welch V Losos M Tugwell P . The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Ottawa Hospital Research Institute. 2021. URL: https:\/\/www.ohri.ca\/programs\/clinical_epidemiology\/oxford.asp [Accessed 25-05-2025]"},{"key":"R38","unstructured":"A cochrane risk of bias assessment tool: for non-randomized studies of interventions (ACROBAT- NRSI). University of Bristol. URL: https:\/\/www.bristol.ac.uk\/media-library\/sites\/social-community-medicine\/images\/centres\/cresyda\/ACROBAT-NRSI%20Version%201_0_0.pdf [Accessed 05-02-2026]"},{"issue":"11","key":"R39","doi-asserted-by":"publisher","first-page":"1539","DOI":"10.1002\/sim.1186","article-title":"Quantifying heterogeneity in a meta-analysis","volume":"21","author":"Higgins","journal-title":"Stat Med"},{"issue":"2","key":"R40","doi-asserted-by":"publisher","first-page":"97","DOI":"10.1002\/jrsm.12","article-title":"A basic introduction to fixed-effect and random-effects models for meta-analysis","volume":"1","author":"Borenstein","journal-title":"Res Synth Methods"},{"issue":"2","key":"R41","doi-asserted-by":"publisher","first-page":"455","DOI":"10.1111\/j.0006-341x.2000.00455.x","article-title":"Trim and fill: a simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis","volume":"56","author":"Duval","journal-title":"Biometrics"},{"issue":"4","key":"R42","doi-asserted-by":"crossref","first-page":"1088","DOI":"10.2307\/2533446","volume":"50","author":"Begg","journal-title":"Biometrics"},{"issue":"7109","key":"R43","doi-asserted-by":"publisher","first-page":"629","DOI":"10.1136\/bmj.315.7109.629","article-title":"Bias in meta-analysis detected by a simple, graphical test","volume":"315","author":"Egger","journal-title":"BMJ"},{"issue":"7","key":"R44","doi-asserted-by":"publisher","first-page":"1783","DOI":"10.1007\/s40620-022-01453-3","article-title":"History of kidney transplantation: a journey of progression and evolution for success","volume":"35","author":"Tantisattamo","journal-title":"J Nephrol"},{"issue":"11","key":"R45","doi-asserted-by":"publisher","first-page":"3803","DOI":"10.1007\/s00467-023-06024-7","article-title":"Long term outcomes following kidney transplantation in children who weighed less than 15 kg - report from the UK Transplant Registry","volume":"38","author":"Pickles","journal-title":"Pediatr Nephrol"},{"issue":"8","key":"R46","doi-asserted-by":"publisher","first-page":"e236","DOI":"10.1097\/TP.0000000000003300","article-title":"Strategy to enable and accelerate kidney transplant in small children and results of the first 130 transplants in children \u226415 kg in a single center","volume":"104","author":"de Feltran","journal-title":"Transplantation"},{"issue":"1","key":"R47","doi-asserted-by":"publisher","DOI":"10.1111\/petr.14631","article-title":"Should children receive a kidney transplant before 2\u2009years of age?","volume":"28","author":"Kizilbash","journal-title":"Pediatr Transplant"},{"issue":"1-2","key":"R48","doi-asserted-by":"publisher","first-page":"259","DOI":"10.1038\/pr.2016.207","article-title":"Pediatric kidney transplantation: a historical review","volume":"81","author":"Verghese","journal-title":"Pediatr Res"},{"issue":"10","key":"R49","doi-asserted-by":"publisher","first-page":"1853","DOI":"10.1007\/s00467-015-3114-6","article-title":"Proteinuria 1 year after renal transplantation is associated with impaired graft survival in children","volume":"30","author":"Ros\u00edk","journal-title":"Pediatr Nephrol"},{"issue":"2","key":"R50","doi-asserted-by":"publisher","DOI":"10.1080\/0886022X.2023.2253324","article-title":"Comparison of three spot proteinuria measurements for pediatric nephrotic syndrome: based on the International Pediatric Nephrology Association 2022 guidelines","volume":"45","author":"Ambarsari","journal-title":"Ren Fail"},{"issue":"10","key":"R51","doi-asserted-by":"publisher","first-page":"1481","DOI":"10.1016\/j.ajt.2023.08.021","article-title":"Predicting graft survival in pediatric kidney transplantation: does the box fit?","volume":"23","author":"Sypek","journal-title":"Am J Transplant"},{"issue":"2","key":"R52","first-page":"S103","volume":"71(Suppl 2)","author":"Ambarsari","journal-title":"J Pak Med Assoc"},{"issue":"6","key":"R53","doi-asserted-by":"publisher","first-page":"1287","DOI":"10.1016\/j.kint.2016.09.054","article-title":"Global trends and challenges in deceased donor kidney allocation","volume":"91","author":"Wu","journal-title":"Kidney Int"},{"issue":"4","key":"R54","doi-asserted-by":"publisher","first-page":"387","DOI":"10.1097\/TP.0b013e3181c9029d","article-title":"A new UK 2006 National Kidney Allocation scheme for deceased heart-beating donor kidneys","volume":"89","author":"Johnson","journal-title":"Transplantation"},{"issue":"2","key":"R55","doi-asserted-by":"publisher","first-page":"38","DOI":"10.5500\/wjt.v5.i2.38","article-title":"Changing organ allocation policy for kidney transplantation in the United States","volume":"5","author":"Chopra","journal-title":"WJT"},{"issue":"1","key":"R56","doi-asserted-by":"publisher","first-page":"10","DOI":"10.1177\/152692480801800103","article-title":"Improving equity of access to deceased donor kidneys in New Zealand","volume":"18","author":"Faire","journal-title":"Prog Transplant"},{"key":"R57","unstructured":"Clinical guidelines for organ transplantation from deceased donors: organ and tissue authority, version 111. The Transplantation Society of Australia and New Zealand. 2023. URL: https:\/\/tsanz.com.au\/storage\/documents\/TSANZ_Clinical_Guidelines_Version-111_13062023Final-Version.pdf [Accessed 25-05-2025]"},{"issue":"1","key":"R58","doi-asserted-by":"publisher","first-page":"2","DOI":"10.1093\/ndt\/gfi269","article-title":"Eurotransplant kidney allocation system (ETKAS): rationale and implementation","volume":"21","author":"Mayer","journal-title":"Nephrol Dial Transplant"},{"key":"R59","doi-asserted-by":"publisher","DOI":"10.1111\/petr.14317","article-title":"Allocation to pediatric recipients around the world: an IPTA global survey of current pediatric solid organ transplantation deceased donation allocation practices","volume":"27 Suppl 1","author":"Hern\u00e1ndez Benabe","journal-title":"Pediatr Transplant"}],"container-title":["JMIR Research Protocols"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.researchprotocols.org\/2026\/1\/e71620","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T18:01:14Z","timestamp":1782842474000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.researchprotocols.org\/2026\/1\/e71620"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,12]]},"references-count":59,"URL":"https:\/\/doi.org\/10.2196\/71620","relation":{},"ISSN":["1929-0748"],"issn-type":[{"value":"1929-0748","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,12]]},"article-number":"v15i6e71620"}}