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Publications

Journal Article Epublish

PubMed: 42553976 DOI: 10.1093/ckj/sfag211

Factors influencing the acceptance of deceased donor kidney transplant offers in children-a vignette survey.

Clin Kidney J 19(8):sfag211

Authors: Leonie Greipel, Xiaofei Liu, Evgenia Preka, Lena Brunkhorst, Burkhard Tönshoff, Dieter Haffner, Nele Kanzelmeyer

Affiliations

  • Department of Pediatric Kidney, Liver, Metabolic and Neurological Diseases, Hannover Medical School, Hannover, Germany. PRACTIS Clinician Scientist Program, Dean's Office for Academic Career Development, Hannover Medical School, Hannover, Germany.
  • Institute for Biostatistics, Hannover Medical School, Hannover, Germany.
  • Université Paris Cité, INSERM U970 PARCC, Paris Institute for Transplantation and Organ Regeneration, Paris, France.
  • Pediatric Nephrology, Necker Enfants Malades University Hospital, Université Paris Cité, Paris, France.
  • Department of Pediatric Kidney, Liver, Metabolic and Neurological Diseases, Hannover Medical School, Hannover, Germany.
  • Heidelberg University, Medical Faculty, Department of Pediatrics I, University Children's Hospital Heidelberg, Heidelberg, Germany.

Abstract

BACKGROUND

Donor kidneys are allocated to potential pediatric kidney transplant recipients based on criteria such as human leukocyte antigen (HLA) immunology, but explicit guidance for accepting deceased-donor kidney offers is lacking.

METHODS

A vignette survey was designed with a matrix of 128 fictitious kidney offers consisting of seven dimensions with two levels each: mismatches on HLA A, B, C (≤3/≥4); mismatches on HLA DR, DQ (≤2/≥3); donor estimated glomerular filtration rate (eGFR) (≥50/≤49 ml/min/1.73 m 2); donor age (≤1/2-50 years); recipient age (≤1/≥2 years); recipient status (preemptive/on dialysis); donor history of sepsis or bacterial infection (yes/no). Between December 2024 and February 2025, clinicians involved in pediatric kidney transplantation evaluated a randomly assigned set of 16 vignettes. Mixed-effects logistic regression assessed factors associated with acceptance.

RESULTS

Forty participants from eleven allocation organizations in Europe, Iran, and Canada, most commonly Eurotransplant (58%), including eight European countries, provided 533 evaluations (3-6 per vignette). In the multivariate analysis, four of the seven vignette dimensions decreased acceptance: ≥4 HLA A, B, C mismatches (P = .011), ≥3 HLA DR, DQ mismatches (P < .001), donor eGFR ≤49 ml/min/1.73 m 2 (P < .001), or donor age ≤1 year (P = .003). Recipient age, dialysis status, and donor sepsis/bacterial infection were not significant. Allocation organization and respondent characteristics (gender and experience) did not materially influence decisions.

CONCLUSIONS

This pilot study suggests that factors such as HLA mismatches, donor eGFR, and donor age, consistently guided decisions, independently of participant's allocation organization. This underscores the potential value of developing evidence-informed donor-offer acceptance guidelines and investigating the impact of these factors on kidney transplantation outcome.

MeSH

Bacterial Infections, Kidney, Graft Survival, Sepsis, Kidney Failure, Chronic, Transplants, Kidney Transplantation, Pediatrics, Transplantation, Infections, Child