The FTKAS has led to effective utilization of the declined kidneys with outcome comparable to kidneys allocated through the standard scheme. Non-participation based on outcome concerns is mostly subjective while logistical issues need to be addressed.
Despite excellent outcome, the referral, donation, and utilization of kidneys from donors younger than 5 years and particularly those younger than 2 years remain low. We suggest implementing improved strategies to increase donation from this group of population.
Kidney transplants from young pediatric donors are uncommonly performed in the UK. Published literature of kidney transplant from donors weighing less than 5 kg is sparse. We present our initial experience of en bloc kidney transplantation (EKT) from donors weighing less than 20 kg, including neonatal donors. All recipients undergoing EKT from donors under 20 kg at our center from January 2005 to October 2016 were included. Donor and recipient details were recorded from a prospective database. Electronic patient records were examined for follow-up data. Of 30 EKTs included, 15 were from ≤5 kg donors and 15 from >5 kg donors (median weight 3.4 and 12.7 kg, respectively). One-year graft survival for ≤5 kg and >5 kg donors for EKT was 86.7% and 93.3% (P = 0.85), respectively. Progressive improvement in estimated GFR (eGFR) was noted in both donor categories through first-year posttransplant but in the ≤5 kg donor category significant improvement was seen at 12 months compared to 3 months after transplantation (median eGFR 37.3 vs 70.0 mL/min/1.73 m , P = 0.03). Two early graft losses were attributable to early vascular complications and one graft loss due to primary nonfunction. Our data show that kidney transplantation from such donors is a feasible option at centers with experience of EKT, albeit with increased risk of early graft loss.
Summary
Following the influenza A H1N1 (swine flu) pandemic, there remains little evidence informing the safety of transplanting organs from donors suspected or diagnosed with H1N1. Limited guidelines from the major transplant societies leave the use of such organs at the discretion of individual transplant centres, and practice varies considerably both nationally and internationally. We present the largest published series of outcome following transplantation of organs from H1N1 positive donors and demonstrate that these organs can be transplanted safely and with good short‐term outcome. We discuss our local policy for treatment of recipients with Oseltamivir.
Current guidelines are vague in their recommendations as to which patients should be imaged prior to renal transplantation and the optimal imaging modality for this purpose. Data on 112 patients who underwent pre-transplant vascular imaging (magnetic resonance angiography or contrast angiography), from a total of 167 evaluated between January 2005 and October 2006, were scrutinized to see whether abnormal results altered clinical management. Several variables were analyzed to determine possible predictors of an abnormal scan result. Sixty-nine patients (61.6%) were either diabetic or aged over 60. Fifty-nine (52.7%) were normal scans, and 53 (47.3%) were abnormal. In the abnormal group, 21 (18.8%) clinical decisions were made. Multivariate analysis revealed that age (OR: 1.1, 1.03-1.13) and diabetes (OR: 3.2, 1.13-9.2) were significant predictors of an abnormal scan. Imaging delayed transplant listing by 83 days. Imaging for all potential transplant recipients is not required and results in unnecessary delay. Risk factors including age and diabetes can be utilized to rationalize imaging via clinical guidelines to target to high-risk groups. The choice of imaging modality in patients with renal insufficiency is not clear cut, but risks and benefits should be addressed on an individual basis and preventative strategies used whenever possible.
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