Neonatal kidney donation and transplantation: a realistic strategy for the treatment of end-stage renal disease

Wijetunga, Imeshi; Pandanaboyana, Sanjay; Farid, Shahid; Ecuyer, C.; Lewington, Andrew; Hostert, L.; Attia, M.; Ahmad, Niaz

doi:10.1136/archdischild-2014-306592

Cited by 6 publications

(6 citation statements)

References 3 publications

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“…The main limitation of this study is the small cohort size, yet this is the largest reported single‐center series of EKT from donors weighing less than 5 kg, including neonatal donors outside the United States . This study includes the previously reported cases by the author . The US experience suggests that high‐volume center experience to an extent mitigates the rates of early graft loss from these young donor kidneys and supports performing these transplants in selected centers …”

Section: Discussionmentioning

confidence: 99%

“…In the United Kingdom, there has been a general reluctance to utilize extremely young donor kidneys, mainly due to reported higher rates of early graft loss among other anxieties that have been described previously . The highest rate of pediatric mortality is observed in the neonatal period, accounting for 18.68 deaths per 1000 live births in 2015, globally .…”

Section: Introductionmentioning

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: 99%

Section: Introductionmentioning

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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“…Recent audits from the neonatal centers in the UK have highlighted that the potential of donation from neonates is significantly higher if these organs can be utilized for transplantation . We have previously reported on the feasibility of EKT from infant and neonatal donors . We have seen a steady expansion of our experience of kidney transplant from infant and neonatal donors in recent years.…”

Section: Discussionmentioning

confidence: 99%

“…10,11 We have previously reported on the feasibility of EKT from infant and neonatal donors. 12,13 We have seen a steady expansion of our experience of kidney transplant from infant and neonatal donors in recent years.…”

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confidence: 99%

Bilateral adrenal hemorrhage in a neonatal kidney donor

Martinez-Lopez

Wijetunga

Ecuyer

et al. 2018

Pediatric Transplantation

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EKT from neonatal donors remains rare despite successful outcome being reported. The surgical aspects of neonatal abdominal organ recovery remain unfamiliar to the vast majority of abdominal organ recovery teams and renal transplant surgeons. BAH is not uncommon in newborn babies suffering distress in the perinatal period. BAH is often also associated with RVT and will impact on utilization of kidneys for transplantation. We present a case of a neonatal kidney donor with massive BAHs discovered at the time of organ recovery. This made the procurement challenging. Both kidneys were recovered en bloc with pancreas and the liver with aorta and inferior vena cave as vascular conduits. The kidneys were successfully implanted into an adult recipient with good function at 1-year follow-up. Association between adrenal hemorrhage and RVT needs to be considered before utilizing such kidneys. This case exemplifies successful outcome after careful assessment and transplantation of such kidneys.

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“…The team should be commended for this milestone achievement. The surgical teams should also be congratulated for embracing the immense challenge of retrieving and transplanting kidneys from such a small donor, a feat which only handful of centres in the UK would undertake due to anxieties that we have previously described 2 3. Organ donation from very young donors is a rare occurrence in the UK, which is a testament to our outstanding neonatal and paediatric care but may also reflect overall lower donation rates compared with other countries.…”

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confidence: 99%