Outcome of Single Pediatric Deceased Donor Renal Transplantation to Adult Kidney Transplant Recipients

Abstract

Introduction: In times of organ shortage more kidneys were transplanted in ‘expanded criteria kidney' programs. This study examines the outcome of adult kidney recipients from pediatric donors. Materials and Methods: This single-center retrospective analysis evaluated eight adult patients who received a kidney from a deceased pediatric donor (age 5-17) between 06/2000 and 09/2011. Results: The median donor age was 14 years (range 5-17). The median recipient age was 49 years (range 25-57). The median cold ischemia time was 13.3 h (range 4.3-20.1), while the median warm ischemia time was 53 min (range 42-60). The median follow-up was 35.8 months (range 7-142). Acute rejection was observed in 50.0% of cases. The median HLA mismatch was 2.0. The median 1-year creatinine level was 0.95 mg/dl, the uncensored 1-year graft survival was 75.0% and the 3-year graft survival 62.5%, respectively. No recipient died within the follow-up period. As severe surgical complications, one stenosis of the renal artery and one lymphocele needing surgical revision were observed. Conclusions: Renal transplantation of a deceased single pediatric donor to an adult recipient can be performed safely and shows a good outcome. Wherever feasible, single pediatric kidney transplantation can double the number of recipients over an ‘en-bloc' transplantation. The price for a single pediatric kidney transplant may be a higher vascular complication rate and a higher rejection risk. Despite the higher risks, transplantation of a single pediatric donor kidney should be performed when accomplishable.

Clinical Outcome of Elderly Kidney Transplant Recipients from Spousal Donors

“…Acceptance criteria for marginal donor kidneys should be expanded [17]. Renal transplantation of a deceased single pediatric donor to an adult recipient can be performed safely and shows a good outcome [18]. In our study, the donor age was high (63.5 ± 5.0 years old), and 15 out of the 21 recipients had donors aged 60 years and older.…”

Kidney transplantation from small pediatric donors may be feasible to those who developed chronic refractory dialysis hypotension: a single-center experience

“…As for pediatric donor transplantation, there are some potential hazards such as a higher vascular and urinary complication rates (3,4,13) and a higher risk of AR and DGF (4,14). It may also lead to hyperfiltration injury and graft failure due to inadequate nephrons (6,12).…”

“…In group A, four patients were on hemodialysis (HD) and one on peritoneal dialysis (PD); in group B, three were on HD, one on PD, and one on PD to start and switched to HD. The median duration of dialysis was 8 (2.5-10.5) years in group A and 4 [1][2][3][4][5][6][7][8][9] years in group B.…”

“…Even though pediatric donor kidney transplantation could lead to ureteral (stenosis or leakage), vascular (venous thrombosis or arterial stenosis) complications, delayed graft function (DGF) and acute rejection (AR) (1,(3)(4)(5)(6), recipients of pediatric donor kidneys have got satisfying long-term outcomes similar to those received adult donor kidneys within standard criteria (2,4,(7)(8)(9)(10)(11)(12). Pediatric donors are used mostly for pediatric recipients and some for adult recipients.…”

En Bloc Dual Kidney Transplantation from Pediatric Donors after Cardiac Death: Initial Experience in China

“…Our recipient 3 (a 10-year-old child weighing 32.0 kg) lost one kidney due to thrombosis, but the remaining graft from an 8-month-old donor (body weight 8.5 kg) performed well. This indicates that if the donor and recipient are well matched, pediatric kidneys can be transplanted as singles, regardless of surgical challenges [22]. …”