Pediatric Kidney Alone Versus Adult Simultaneous Kidney–Pancreas Recipients of Deceased Donor Kidneys: A Paired Analysis of 1675 Donors
Joseph Sushil Rao, Shrihari Nagarajan, Prithvi Nagarajan, Ruining Zhou, Jando Danial, Ahalya Ramesh, Matthew Wright, Michael Chobanian, Michael F. Daily, Raja Kandaswamy, Abraham J. MatarABSTRACT
Background
Allocation of high quality deceased donor kidneys to simultaneous pancreas–kidney (SPK) versus pediatric kidney alone (KI) recipients presents competing priorities regarding kidney allograft longevity and patient survival. We evaluated long‐term outcomes of contralateral kidneys transplanted into these distinct recipient populations to assess kidney allograft utility within this allocation framework.
Methods
Using Scientific Registry of Transplant Recipients data from 2010–2025, we identified 1675 deceased donors whose kidneys were transplanted into an adult SPK recipient and a pediatric KI recipient. Outcomes included death censored graft survival (DCGS), patient survival, and freedom from composite graft failure or death. Kaplan–Meier analyses were performed with survival estimates at 1, 3, 5, and 10 years and log‐rank comparisons.
Results
Ten‐year DCGS was significantly higher among adult SPK recipients than among pediatric KI recipients (82.1% versus 70.6%; p = 0.0001). Conversely, 10‐year patient survival was substantially higher among pediatric KI recipients (95.4% versus 78.3%; p = 0.0001). Despite these differences, 10‐year freedom from composite graft failure or death was comparable between SPK and pediatric KI recipients (69.1% versus 67.9%; p = 0.47).
Conclusions
Among contralateral kidneys from the same deceased donors, adult SPK recipients demonstrated superior DCGS, whereas pediatric KI recipients experienced substantially better patient survival. Comparable long‐term composite outcomes highlight the competing considerations of graft longevity and recipient survival in deceased donor kidney allocation. These findings suggest that assessments of kidney allograft utility should consider both graft‐specific and recipient‐centered outcomes rather than relying on either endpoint independently.