Factors influencing the acceptance of deceased donor kidney transplant offers in children—a vignette survey
Source: PubMed Central Open Access, NCBI / U.S. National Library of Medicine
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. abs1 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); 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. abs2 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 (= .011), ≥3 HLA DR, DQ mismatches (< .001), donor eGFR ≤49 ml/min/1.73 m(< .001), or donor age ≤1 year (= .003). Recipient age, dialysis status, and donor sepsis/bacterial infection were not significant. Allocation organization and respondent characteri
Abstract
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. abs1 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); 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. abs2 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 (= .011), ≥3 HLA DR, DQ mismatches (< .001), donor eGFR ≤49 ml/min/1.73 m(< .001), or donor age ≤1 year (= .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. abs3 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. abs4 Graphical Abstract Graphical Abstract For image description, please refer to the figure legend and surrounding text. http://www.w3.org/1999/xlink float portrait sfag211gra.jpg float ga1 portrait graphical