En Bloc Transplantation of Kidneys from Pediatric Donors

Amante, Angel J.; Kahan, Barry D.

doi:10.1016/s0022-5347(01)66326-2

Cited by 31 publications

(18 citation statements)

References 21 publications

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“…found that pediatric recipients of variable ages who received SKs (except for one EB) had 100% 10‐year graft survival when the donor was ≤3 years old (n=18) and 73.2% 10‐year graft survival with donors 3‐6 years of age (n=14). Amante and Kahan reported successful short‐term graft survival with EB transplantation of kidneys from donors ≤6 years of age into 2 older children (age 12) . In a much larger study of 6882 recipients, Winnicki and others reported similar overall graft survival of pediatric recipients receiving EB kidneys from donors 1‐3 years of age (HR, 1.15; 95% CI, 0.83‐1.59) compared to standard adult deceased‐donor transplants in the OPTN registry …”

Section: Discussionmentioning

confidence: 95%

“…Studies in support of utilizing small and/or very small pediatric donor kidneys for children are largely single‐center, low sample size analyses, except for one registry study . Filler et al .…”

Section: Discussionmentioning

confidence: 99%

“…This national study of pediatric kidney transplantation from very small pediatric donors weighing 10-20 kg shows that the majority of these kidneys were transplanted into adult recipients and, over time, were Studies in support of utilizing small and/or very small pediatric donor kidneys for children are largely single-center, low sample size analyses, 19,20,22 except for one registry study. 23 Filler et al 19 25 Our study also suggests that with increasing recipient body mass, graft survival of small pediatric EB grafts approaches that of adult donors.…”

Section: Discussionmentioning

confidence: 99%

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Very small pediatric donor kidney transplantation in pediatric recipients

Yaffe

Friedmann

Kayler

2017

Pediatric Transplantation

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Kidneys from very small pediatric donors (age <5 years, weight <21 kg) may be a means to increase the donor pool for pediatric recipients. Transplantation of small pediatric kidneys is more commonly performed in adult recipients due to the increased risks of technical complications, thrombosis, and early graft failure. While these risks are abrogated in adult recipients by limiting the donor weight to ≥10 kg and using the EB technique, it is unknown whether pediatric recipients achieve comparable results. US national data were assessed for all first-time, deceased-donor, kidney-only pediatric recipients, 1/1996-10/2013, who received very small pediatric donor grafts or grafts from ideal adult donors. We identified 57 pediatric EB, 110 pediatric SK, and 2350 adult transplants. The primary outcome was 3-year all-cause graft survival. Kaplan-Meier curves showed worse outcomes for pediatric grafts compared to adult ideal grafts (P=.042). On multivariate analysis, pediatric recipients of SK grafts had significantly higher HRs (aHR 2.01, 95% CI 1.34-3.00) and pediatric recipients of EB grafts had somewhat higher non-significant HRs (1.57; 95% CI 0.88-2.79) for graft survival. These results suggest cautionary use of very small pediatric donors as a source to expand the donor pool for pediatric candidates.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Very small pediatric donor kidney transplantation in pediatric recipients

Yaffe

Friedmann

Kayler

2017

Pediatric Transplantation

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“…Pediatric kidneys have long been transplanted in adult patients with good results. Even younger donors, less than 5 years old, have been successfully used, especially since the advent of appropriate transplantation techniques such as the en bloc technique (1–4).…”

Section: Introductionmentioning

confidence: 99%

Pediatric En Bloc Dual Kidney-Pancreas Transplantation Into an Adult Recipient: a Simplified Technique. Benefits of the en bloc kidney-pancreas transplantation technique in pediatric donors

Buggenhout¹,

Hoang²,

Hut³

et al. 2004

American Journal of Transplantation

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The lower age limit for pancreas donors is not well defined. Fear of inadequate islet b -cell mass and of technical complications has hampered the use of pediatric donors. A surgical technique of 'en bloc' kidneypancreas is described.Both kidneys and pancreas were removed en bloc from a 13-kg, 31-month-old child. During bench preparation, one anastomosis was performed between the portal vein and the inferior vena cava. The proximal end of the aorta was closed. The bloc was transplanted into a 36-year-old type I diabetic patient intraperitoneally in the right iliac fossa.The kidneys functioned immediately. Pancreatic graft function resumed after POD 15 but insulin therapy was maintained until POD 112. Currently, the patient retains excellent kidney and pancreas graft functions.Very young donors can be accepted as pancreas donors for adult recipients, although slow recovery of pancreatic function can be expected. Use of the en bloc technique is well suited for very small children, as it prevents potential vascular complications.

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“…For example, the concern regarding the reduced renal mass of paediatric grafts has been addressed by the use of en‐bloc double kidneys, in which both paediatric kidneys from a single donor are transplanted into one recipient. Yet en‐bloc transplantation is a more technically challenging surgical procedure which has been associated with a higher incidence of both vascular and ureteral complications, although a number of centres have reported excellent long‐term outcomes (4–8). Recently there has been interest in the transplantation of single paediatric grafts into adult recipients (9–11).…”

mentioning

confidence: 99%