Kidney transplant using pediatric donors—effect on long-term graft and patient survival

Arrazola, Luis; Sozen, H.; Humar, Abhinav; Papalois, V; Uknis, Marc E.; Matas, Arthur J.

doi:10.1016/s0041-1345(00)01455-x

Cited by 6 publications

(8 citation statements)

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“…Recently, there have been multiple reports on the use of pediatric kidney donors. While some suggest a lower graft survival (10,11,24) others have reported comparable graft survival and function to those from adult donors (12)(13)(14)25). In contrast to studies suggesting that early graft failure and smaller nephron mass result in poorer graft survival, our data suggest that the use of pediatric donors in SPK transplantation results in better kidney and pancreas graft survival in adult recipients of pediatric donor organs when compared to adult recipients of adult donor organs.…”

Section: Discussioncontrasting

confidence: 68%

“…In the past, pediatric organs have been considered marginal for use as a result of smaller nephron mass, increased surgical complications, primary non-function and rejection (8,10,12,(14)(15)(16). Recently, there have been multiple reports on the use of pediatric kidney donors.…”

Section: Discussionmentioning

confidence: 99%

“…The use of pediatric kidney donors is controversial based on several reports demonstrating poor functional outcome, a higher incidence of rejection, worse graft and patient survival rates and a higher incidence of surgical complications including vascular thrombosis, renal artery stenosis, hydronephrosis and urinary leak (6)(7)(8)(9). In addition, concerns have been raised over the difference between donor renal mass and recipient body mass index (BMI) (10). In particular, a review of the United Network for Organ Sharing (UNOS) database from 1988 to 1995 reported poorer graft survival in recipients of organs from pediatric donors, improved graft survival with the use of en bloc kidneys and improved graft survival with the use of organs from donors ≥6 years of age in comparison to donors <5 years of age (11).…”

Section: Introductionmentioning

confidence: 99%

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Superior Long-Term Results of Simultaneous Pancreas–Kidney Transplantation from Pediatric Donors

Fernández

Turgeon

Odorico

et al. 2004

American Journal of Transplantation

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The shortage of cadaveric donors for simultaneous pancreas-kidney transplantation has prompted the use of cadaveric organs from pediatric donors. The long-term outcome and its impact on overall longterm survival are unknown. A total of 680 recipients receiving cadaver Simultaneous pancreas-kidney (SPK) transplantation from pediatric and adult donors between July 1986 and September 2001 were analyzed and compared. Ten-year kidney and pancreas graft survival for SPK transplantation from donors aged <18 years (n = 142) were 80% and 72%, respectively, compared to 61% pancreas and kidney graft survival from donors ≥18 years of age (n = 538; p = 0.03 and 0.05, respectively). Five years post-transplant, blood glucose, HbA 1 c and creatinine clearance were significantly better in recipients from pediatric donors (85.3 ± 13 mg/dL, 5.5 ± 3.5% and 65.6 ± 16 mL/min, respectively), compared to recipients from adult donors (95.1 ± 29 mg/dL, 5.9 ± 3.5% and 58.3 ± 17 mL/min; p = 0.001, 0.01 and 0.002, respectively). Causes of graft failure for kidney and pancreas transplants were similar between the two groups. No statistically significant difference was observed in patient survival between recipients from pediatric donors compared to adult donors (85% vs. 76%, p = 0.29). When recipients of SPK from pediatric donors were stratified according to age (3-11 years and 12-17 years) and compared, no difference in kidney or pancreas graft survival was observed (kidney 76.4% vs. 81.3%, p = 0.15; pancreas 75% vs. 76%, p = 0.10, respectively). Pediatric donors represent a valuable source of organs, providing excellent short-and long-term outcomes. Wide utilization of pediatric organs will substantially increase the donor pool.

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Section: Discussioncontrasting

confidence: 68%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Superior Long-Term Results of Simultaneous Pancreas–Kidney Transplantation from Pediatric Donors

Fernández

Turgeon

Odorico

et al. 2004

American Journal of Transplantation

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“…A high incidence of acute rejection has been reported after pediatric-donor kidney transplantation (4,8,12). This may be related to the higher incidence of DGF and hyperfiltration injury, which can upregulate the expression of HLA and/or other antigens in pediatric kidneys.…”

Section: Discussionmentioning

confidence: 99%

“…Mixed results have been reported (4)(5)(6)(7)(8)(9). The technical concerns of vascular and ureteral complications (4,5,10,11) and the medical concerns of delayed graft function (DGF), rejection, and hyperfiltration injury have been raised (4,8,12).…”

mentioning

confidence: 99%

Long-Term Outcome of Adults Who Undergo Transplantation with Single Pediatric Kidneys

Zhang

Paramesh²,

Florman³

et al. 2009

Clinical Journal of the American Society of Nephrology

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Background and objectives: The optimal donor age for transplanting a single pediatric kidney in an adult recipient remains unknown. En block kidney transplantation is usually performed when the donor age is <5 yr.Design, setting, participants, & measurements: We compared the outcomes of adult patients who underwent transplantation with single pediatric kidneys from donors who were younger than 5 yr (group 1, n ‫؍‬ 40) and from donors who were aged 5 to 10 yr of age (group 2, n ‫؍‬ 39) in our center.Results: The donor kidney sizes were significantly smaller in group 1 than in group 2 (P < 0.001), and group 1 required more ureteral stents than group 2 (73 versus 38%). The surgical complications, delayed graft function, and development of proteinuria were similar in both groups. Group 1 had slightly higher rejection episodes than group 2 (25 versus 18%; P ‫؍‬ 0.67), and graft function was comparable in both groups. There were no statistical differences between the two groups in patient (P ‫؍‬ 0.73) or death-censored graft (P ‫؍‬ 0.68) survivals over 5 yr.Conclusions: Single pediatric kidney transplants from donors who are younger than 5 yr can be used with acceptable complications and long-term outcomes as those from older donors.

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Outcomes and Discard of Kidneys From Pediatric Donors After Cardiac Death

Dagher

Lonze²,

Singer

et al. 2011

Transplantation

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Kidney transplant using pediatric donors—effect on long-term graft and patient survival

Cited by 6 publications

References 0 publications

Superior Long-Term Results of Simultaneous Pancreas–Kidney Transplantation from Pediatric Donors

Superior Long-Term Results of Simultaneous Pancreas–Kidney Transplantation from Pediatric Donors

Long-Term Outcome of Adults Who Undergo Transplantation with Single Pediatric Kidneys

Outcomes and Discard of Kidneys From Pediatric Donors After Cardiac Death

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