Outcomes of kidney transplantations in children weighing 15 kilograms or less: a retrospective cohort study

Abstract

Kidney transplantation (KT) is often delayed in small children because of fear of postoperative complications. We report early- and long-term outcomes in children transplanted at ≤15 kg in the two largest Belgian pediatric transplant centers. Outcomes before (period 1) and since the introduction of basiliximab and mycophenolate-mofetil in 2000 (period 2) were compared. Seventy-two KTs were realized between 1978 and 2016: 38 in period 1 and 34 in period 2. Organs came from deceased donors in 48 (67%) cases. Surgical complications occurred in 25 KTs (35%) with no significant difference between the two periods. At least one acute rejection (AR) occurred in 24 (33%) KTs with significantly less patients experiencing AR during period 2: 53% and 12% in period 1 and, period 2 respectively (P < 0.001). Graft survival free of AR improved significantly in period 2 compared with period 1: 97% vs. 50% at 1 year; 87% vs. 50% at 10 years post-KT (P = 0.003). Graft survival tended to increase over time (period 1: 74% and 63% at 1 and 5 years; period 2: 94% and 86% at 1 and 5 years; P = 0.07), as well as patient survival. Kidney transplantation in children ≤15 kg remains a challenging procedure with 35% of surgical complications. However, outcomes improved and are nowadays excellent in terms of prevention of AR, patient and graft survival.

Perioperative renal transplantation management in small children using adult‐sized living or deceased donor kidneys: A single‐center experience

“…The use of our protocol has resulted in both patient and graft survival that compare favorably with recently published studies . In particular, DGF occurred in two (3.2%) patients in our study population, as compared to 6%‐10% reported in prior studies .…”

“…The use of our protocol has resulted in both patient and graft survival that compare favorably with recently published studies . In particular, DGF occurred in two (3.2%) patients in our study population, as compared to 6%‐10% reported in prior studies . Due to multiple factors, ranging from cold ischemia time, hypotension, and donor age, DGF is a significant risk factor for the development of both acute rejection and subsequent graft loss .…”

“…10,[23][24][25][26] In particular, DGF occurred in two (3.2%) patients in our study population, as compared to 6%-10% reported in prior studies. 10,23 Due to multiple factors, ranging from cold ischemia time, hypotension, and donor age, DGF is a significant risk factor for the development of both acute rejection and subsequent graft loss. 27 In total, six patients in our study developed evidence of ACR and nine with chronic rejection, none of whom had any prior episodes of delayed graft function or acute rejection episodes.…”

“…Taken together, allograft survival within our cohort compares favorably to the 2016 SRTR data for pediatric renal transplant recipients with reported 1, 5, and 10‐year all‐cause graft failure rates of 3.3%, 18.2%, and 45.8% for deceased donor allografts, and 3.3%, 11.5%, and 30.5% for living donor renal transplants . This finding is key, as this comparison is against pooled national data from all pediatric renal transplant recipients which includes older, larger children who historically have not only been viewed as more optimal transplant candidates but have improved post‐transplant outcomes as well …”

“…9 Outcomes in this group following transplantation using living-and deceased donor ASKs have continued to improve, with decreased rates of post-operative complications such as renal vein thrombosis, bleeding, ACR, and DGF, as well as increased 1-, 5-, and 10-year patient and allograft survival. 10 In this report, we present our experience and outcomes using both deceased and living donor ASKs as allografts in small pediatric recipients.…”