Renal Transplantation From Pediatric Donors in the United Kingdom

Abstract

Despite excellent outcome, the referral, donation, and utilization of kidneys from donors younger than 5 years and particularly those younger than 2 years remain low. We suggest implementing improved strategies to increase donation from this group of population.

Singlevsdual (en bloc) kidney transplants from donors ≤ 5 years of age: A single center experience

“…Small pediatric donor KT is gaining wider acceptance but is still regarded as controversial by some and is not universally accepted. The total number of nephrons in each kidney (estimated at a mean of approximately 1.0 million) is attained by 36 wk of gestation; subsequent renal "growth" occurs by hypertrophy rather than increases in nephron number [40,41] . Excellent outcomes with pediatric dual EB KT have been published from recent reports, which in theory reduces concerns regarding functional outcomes and graft longevity because of the potential for growth coupled with the increased nephron mass associated with transplantation of both kidneys [20,3133] .…”

“…The primary reason to avoid transplanting small pediatric donor kidneys into pediatric recipients (in the absence of a primary renal disease with a high recurrence rate) is to avoid anastomosing small donor vessels to small recipient vessels in relatively hypotensive (compared to adults) patients, which may result in early technical failure. At present, 90% of all pediatric DD kidneys are transplanted into adult recipients, 37% of whom are aged 50 years and older [41] . However, recent studies are beginning to question the prohibition of pediatric recipients from receiving pediatric donor kidneys as improving results are being reported and size matching between donors and recipients seems logical from a functional and growth perspective [21,29] .…”

Bilateral adrenal hemorrhage in a neonatal kidney donor

“…Similar expansion has not happened in kidney transplant from infant and neonatal donors. In a review of the UK data, we found a kidney transplant rate of one transplant per year from donors less than 2 years of age over a 15‐year study period . Several plausible reasons are cited for the reluctance in utilizing this donor pool for renal transplantation, including perceived inadequate nephron mass, risk of dysplasia, increased risk of vascular thrombosis, and risk of premature graft failure due to hyperfiltration injury …”

Challenges of paediatric organ donation

“…Even at lower extremes of size and age, multi‐visceral donation has been described . Outcomes of kidney transplantation from infant donors suggest an equivalent survival to older donors . Importantly, for neonates who die, death occurs in a timeframe permissible for donation and families in this position sometimes enquire about the possibility.…”