Current status of pediatric donor en bloc kidney transplantation to young adult recipients

Lorenté, David; Trilla, E.; Serón, Daniel; Moreso, Josep Lluís Piñol; Moróte, Juan

doi:10.1016/j.acuroe.2012.11.007

Cited by 3 publications

(3 citation statements)

References 15 publications

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“…The increased risk of vascular complications with EKT is widely reported including both arterial and venous thrombosis . Although there is no evidence for use in EKT, experience from simultaneous kidney pancreas transplantation supports the perioperative use of low‐dose intravenous heparin with significant reduction in graft thrombosis …”

Section: Discussionmentioning

confidence: 94%

“…Back table preparation involved careful dissection of the perinephric fat and preparation of donor AA and IVC for implantation. If suprarenal segments of AA and IVC were of inadequate length, the infrarenal AA and IVC were divided below the renal arteries and veins, the infrarenal segments of AA and IVC then “switched” to suprarenal position and the distal ends of AA and IVC sutured closed on the back table to facilitate implantation as shown in Figure (Leeds technique) . When liver was not retrieved or retrieved only for hepatocytes, ample length of AA and IVC above the renal vessels were retrieved and a switch was not required.…”

Section: Methodsmentioning

confidence: 99%

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Renal transplant from infant and neonatal donors is a feasible option for the treatment of end-stage renal disease but is associated with increased early graft loss

Wijetunga

Ecuyer

Martinez-Lopez

et al. 2018

American Journal of Transplantation

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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.

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Section: Discussionmentioning

confidence: 94%

Section: Methodsmentioning

confidence: 99%

Renal transplant from infant and neonatal donors is a feasible option for the treatment of end-stage renal disease but is associated with increased early graft loss

Wijetunga

Ecuyer

Martinez-Lopez

et al. 2018

American Journal of Transplantation

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“…However, improved surgical techniques and immunosuppression regimen has further enhanced paediatric kidney donor transplant survival. Recent evidence demonstrates that paediatric EBK transplants with a donor age younger than 5 years had excellent long‐term graft survival among deceased donor transplants …”

mentioning

confidence: 99%

Paediatric en bloc kidney transplantation from a donor less than 5 kg

Lo‐Cao

Yao

Robertson

et al. 2019

ANZ Journal of Surgery

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We report a case of the smallest paediatric en bloc kidney (EBK) transplantation in Australia and New Zealand. Dual EBKs were procured from a 4-month-old female donor, corrected age of 5 weeks, with a body weight of 4.2 kg. The donor was diagnosed as brain dead. The recipient was a 43-year-old male with a body weight of 70 kg and a diagnosis of end stage renal failure secondary to reflux nephropathy. The recipient had been on haemodialysis for 50 months with a baseline creatinine of 800-1000 μmol/L and was oliguric. Comorbidities include hypertension and hypercholesterolaemia. Human leukocyte antigen typing yielded five of six mismatches. There was one Class II donor-specific antibody identified with a weak mean fluorescence intensity of 509. T cell and B cell crossmatch was negative. Cold ischaemic time of the kidneys was 16 h due to a long transit time across Australia. Meticulous backtable dissection of the kidneys was performed involving the removal of perinephric fat from both kidneys and skeletonization of the aorta and inferior vena cava. The cephalic ends of the aorta and suprarenal vena cava were oversewn with 6-0 Prolene, Ethicon, Bridgewater, New Jersey. The aorta was spatulated at its bifurcation and both kidneys and vessels were marked with blue ink anteriorly. The kidneys were wrapped in a 'swab sandwich' to prevent torsion during implantation (Fig. 1), a technique described previously. 1 A standard right Rutherford Morrison incision was used for the recipient and the iliac vessels exposed in the extraperitoneal plane. The donor inferior vena cava and aorta were anastomosed to the recipient external iliac vein and external iliac artery, respectively, in an end to side fashion with 6-0 Prolene. The bladder was filled to capacity. Two separate cystotomies were made in the right dome and anterior wall of the

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Successful Pediatric Kidney Transplantation Into an Adult Recipient: A Case Report

Kuczborska

Gozdowska

Chmura

et al. 2018

Transplantation Proceedings

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Current status of pediatric donor en bloc kidney transplantation to young adult recipients

Cited by 3 publications

References 15 publications

Renal transplant from infant and neonatal donors is a feasible option for the treatment of end-stage renal disease but is associated with increased early graft loss

Renal transplant from infant and neonatal donors is a feasible option for the treatment of end-stage renal disease but is associated with increased early graft loss

Paediatric en bloc kidney transplantation from a donor less than 5 kg

Successful Pediatric Kidney Transplantation Into an Adult Recipient: A Case Report

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