{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T20:54:55Z","timestamp":1781124895444,"version":"3.54.1"},"reference-count":36,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,6,2]],"date-time":"2023-06-02T00:00:00Z","timestamp":1685664000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>The UK kidney offering scheme introduced a kidney donor risk index (UK-KDRI) to improve the utility of deceased-donor kidney allocations. The UK-KDRI was derived using adult donor and recipient data. We assessed this in a paediatric cohort from the UK transplant registry.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We performed Cox survival analysis on first kidney-only deceased brain-dead transplants in paediatric (&amp;lt;18 years) recipients from 2000-2014. The primary outcome was death-censored allograft survival &amp;gt;30 days post-transplant. The main study variable was UK-KDRI derived from seven donor risk-factors, categorised into four groups (D1-low risk, D2, D3 and D4-highest risk). Follow-up ended on 31-December-2021.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>319\/908 patients experienced transplant loss with rejection as the main cause (55%). The majority of paediatric patients received donors from D1 donors (64%). There was an increase in D2-4 donors during the study period, whilst the level of HLA mismatching improved. The KDRI was not associated with allograft failure. In multi-variate analysis, increasing recipient age [adjusted HR and 95%CI: 1.05(1.03-1.08) per-year, p&amp;lt;0.001], recipient minority ethnic group [1.28(1.01-1.63), p&amp;lt;0.05), dialysis before transplant [1.38(1.04-1.81), p&amp;lt;0.005], donor height [0.99 (0.98-1.00) per centimetre, p&amp;lt;0.05] and level of HLA mismatch [Level 3: 1.92(1.19-3.11); Level 4: 2.40(1.26-4.58) versus Level 1, p&amp;lt;0.01] were associated with worse outcomes. Patients with Level 1 and 2 HLA mismatches (0 DR +0\/1 B mismatch) had median graft survival &amp;gt;17 years regardless of UK-KDRI groups. Increasing donor age was marginally associated with worse allograft survival [1.01 (1.00-1.01) per year, p=0.05].<\/jats:p><\/jats:sec><jats:sec><jats:title>Summary<\/jats:title><jats:p>Adult donor risk scores were not associated with long-term allograft survival in paediatric patients. The level of HLA mismatch had the most profound effect on survival. Risk models based on adult data alone may not have the same validity for paediatric patients and therefore all age-groups should be included in future risk prediction models.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fimmu.2023.1207145","type":"journal-article","created":{"date-parts":[[2023,6,2]],"date-time":"2023-06-02T14:06:55Z","timestamp":1685714815000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":7,"title":["The UK kidney donor risk index poorly predicts long-term transplant survival in paediatric kidney transplant recipients"],"prefix":"10.3389","volume":"14","author":[{"given":"Jon Jin","family":"Kim","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca M. K.","family":"Curtis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ben","family":"Reynolds","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen\u00a0D.","family":"Marks","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Drage","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vasilis","family":"Kosmoliaptsis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Dudley","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alun","family":"Williams","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,6,2]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"28","DOI":"10.6061\/clinics\/2014(Sup01)06","article-title":"Long-term outcomes of children after solid organ transplantation","volume":"69","author":"Kim","year":"2014","journal-title":"Clinics"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0b013e3181a9ec89","article-title":"A lifetime versus a graft life approach redefines the importance of HLA matching in kidney transplant patients","volume":"88","author":"Meier-Kriesche","year":"2009","journal-title":"Transplantation"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfn542","article-title":"Characteristics and survival of young adults who started renal replacement therapy during childhood","volume":"24","author":"Kramer","year":"2009","journal-title":"Nephrol Dialysis Transplant"},{"key":"B4","doi-asserted-by":"publisher","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","year":"2019","journal-title":"Transplant Int [Internet]."},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1007\/s00467-019-04362-z","article-title":"Donor considerations in pediatric kidney transplantation","volume":"36","author":"Chandar","year":"2021","journal-title":"Pediatr Nephrol"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1681\/ASN.2013070784","article-title":"New national allocation policy for deceased donor kidneys in the united states and possible effect on patient outcomes","volume":"25","author":"Israni","year":"2014","journal-title":"J Am Soc Nephrol."},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1016\/j.kint.2016.09.054","article-title":"Global trends and challenges in deceased donor kidney allocation","volume":"91","author":"Wu","year":"2017","journal-title":"Kidney Int"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1007\/s40472-020-00270-6","article-title":"Overview of the evolution of the UK kidney allocation schemes","volume":"7","author":"Watson","year":"2020","journal-title":"Curr Transplant Rep Springer;"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0b013e3181ac620b","article-title":"A comprehensive risk quantification score for deceased donor kidneys: the kidney donor risk index","volume":"88","author":"Rao","year":"2009","journal-title":"Transplantation"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.15419","article-title":"Pediatric deceased donor kidney transplant outcomes under the kidney allocation system","volume":"19","author":"Jackson","year":"2019","journal-title":"Am J Transplant"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0000000000001028","article-title":"Kidney donor profile index does not accurately predict the graft survival of pediatric deceased donor kidneys","volume":"100","author":"Parker","year":"2016","journal-title":"Transplantation"},{"key":"B12","volume-title":"Proposed kidney offering scheme","author":"Mumford","year":"2018"},{"key":"B13","volume-title":"Kidney Transplantation: deceased donor organ allocation copy number effective summary of significant changes POLICY POL186\/10 kidney Transplantation: deceased donor organ allocation","year":"2019"},{"key":"B14","volume-title":"Kidney Transplantation: deceased donor organ allocation copynumber effective summary of significant changes POLICY POL186\/10 kidneyTransplantation: deceased donor organ allocation","year":"2019"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0b013e31823f14d4","article-title":"A simplified donor risk index for predicting outcome after deceased donor kidney transplantation","volume":"93","author":"Watson","year":"2012","journal-title":"Transplantation"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfz090","article-title":"External validation of the US and UK kidney donor risk indices for deceased donor kidney transplant survival in the Australian and new Zealand population","volume":"34","author":"Clayton","year":"2019","journal-title":"Nephrol Dialysis Transplant"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0000000000001889","article-title":"Validation of the prognostic kidney donor risk index scoring system of deceased donors for renal transplantation in the Netherlands","volume":"102","author":"Peters-Sengers","year":"2018","journal-title":"Transplantation"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1016\/j.kint.2020.11.016","article-title":"Development and external validation study combining existing models and recent data into an up-to-date prediction model for evaluating kidneys from older deceased donors for transplantation","volume":"99","author":"Ramspek","year":"2021","journal-title":"Kidney Int"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1007\/s00467-022-05722-y","article-title":"A modified kidney donor risk index for pediatric kidney transplant recipients","volume":"38","author":"Montgomery","year":"2022","journal-title":"Pediatr Nephrol"},{"key":"B20","volume-title":"Annual Report on Kidney Transplantation","year":"2022"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1007\/s00467-018-3969-4","article-title":"Renal allograft survival rates in kidneys initially declined for paediatric transplantation","volume":"33","author":"Marlais","year":"2018","journal-title":"Pediatr Nephrology."},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.3389\/ti.2022.10482","article-title":"Deceased donor characteristics and kidney transplant outcomes","volume":"35","author":"Sharif","year":"2022","journal-title":"Transplant Int"},{"key":"B23","doi-asserted-by":"publisher","first-page":"101516","DOI":"10.1016\/j.eclinm.2022.101516","article-title":"Donor characteristics and their impact on kidney transplantation outcomes: results from two nationwide instrumental variable analyses based on outcomes of donor kidney pairs accepted for transplantation","volume":"50","author":"Schaapherder","year":"2022","journal-title":"EClinicalMedicine"},{"key":"B24","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1016\/j.eclinm.2018.09.007","article-title":"Equivalent long-term transplantation outcomes for kidneys donated after brain death and cardiac death: conclusions from a nationwide evaluation","volume":"4","author":"Schaapherder","year":"2018","journal-title":"EClinicalMedicine"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1007\/s00467-015-3175-6","article-title":"Kidney donation after circulatory death: current evidence and opportunities for pediatric recipients","volume":"31","author":"Marlais","year":"2015","journal-title":"Pediatr Nephrol"},{"key":"B26","doi-asserted-by":"publisher","first-page":"1177","DOI":"10.1097\/TP.0000000000001264","article-title":"Original clinical Science\u00e7General UK national registry study of kidney donation after circulatory death for pediatric recipients","volume":"101","author":"Marlais","year":"2017","journal-title":"Transplantation"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1038\/ki.2015.88","article-title":"Kidney donation after circulatory death (DCD): state of the art","volume":"88","author":"Summers","year":"2015","journal-title":"Kidney Int"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2019.18634","article-title":"Association of deceased donor acute kidney injury with recipient graft survival","volume":"3","author":"Liu","year":"2020","journal-title":"JAMA Netw Open"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.2215\/CJN.02310220","article-title":"Donor age, donor-recipient size mismatch, and kidney graft survival","volume":"15","author":"Lepeytre","year":"2020","journal-title":"Clin J Am Soc Nephrology."},{"key":"B30","doi-asserted-by":"publisher","first-page":"100980","DOI":"10.1016\/j.eclinm.2021.100980","article-title":"Donor age and KDPI association with graft survival","volume":"37","author":"Pruett","year":"2021","journal-title":"EClinicalMedicine"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2019.02701","article-title":"Kidneys from elderly deceased donors\u2013is 70 the new 60","volume":"10","author":"Echterdiek","year":"2019","journal-title":"Front Immunol"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfx261","article-title":"The association of donor and recipient age with graft survival in paediatric renal transplant recipients in a European society for paediatric Nephrology\/European renal association-European dialysis and transplantation association registry study","volume":"32","author":"Chesnaye","year":"2017","journal-title":"Nephrol Dialysis Transplantation."},{"key":"B33","doi-asserted-by":"publisher","DOI":"10.1097\/01.tp.0000269725.74189.b9","article-title":"Effect of human leukocyte antigen compatibility on kidney graft survival: comparative analysis of two decades","volume":"84","author":"Opelz","year":"2007","journal-title":"Transplantation"},{"key":"B34","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0b013e318298f9db","article-title":"Relative importance of HLA mismatch and donor age to graft survival in young kidney transplant recipients","volume":"96","author":"Foster","year":"2013","journal-title":"Transplantation"},{"key":"B35","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","year":"2021","journal-title":"Pediatr Nephrol"},{"key":"B36","doi-asserted-by":"publisher","first-page":"e365","DOI":"10.1097\/TXD.0000000000000801","article-title":"The risk of failure with HLA mismatch and recipient age in first pediatric (&lt;18 years) kidney transplants","volume":"4","author":"Williams","year":"2018","journal-title":"Transplant Direct"}],"container-title":["Frontiers in Immunology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fimmu.2023.1207145\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,6,2]],"date-time":"2023-06-02T14:07:04Z","timestamp":1685714824000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fimmu.2023.1207145\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,6,2]]},"references-count":36,"alternative-id":["10.3389\/fimmu.2023.1207145"],"URL":"https:\/\/doi.org\/10.3389\/fimmu.2023.1207145","relation":{},"ISSN":["1664-3224"],"issn-type":[{"value":"1664-3224","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,6,2]]},"article-number":"1207145"}}