Short- and Long-term Outcomes of Kidney Transplants From Very Small (≤15 kg) Pediatric Donors With Acute Kidney Injury

Abstract

Background. Kidneys from small deceased pediatric donors with acute kidney injury (AKI) are commonly discarded owing to transplant centers’ concerns regarding potentially inferior short- and long-term posttransplant outcomes. Methods. We retrospectively analyzed our center’s en bloc kidney transplants performed from November 2007 to January 2015 from donors ≤15 kg into adult recipients (≥18 y). We pair-matched grafts from 27 consecutive donors with AKI versus 27 without AKI for donor weight, donation after circulatory death status, and preservation time. Results. For AKI versus non-AKI donors, median weight was 7.5 versus 7.1 kg; terminal creatinine was 1.7 (range, 1.1–3.3) versus 0.3 mg/dL (0.1–0.9). Early graft loss rate from thrombosis or primary nonfunction was 11% for both groups. Delayed graft function rate was higher for AKI (52%) versus non-AKI (15%) grafts (P = 0.004). Median estimated glomerular filtration rate was lower for AKI recipients only at 1 and 3 months (P < 0.03). Graft survival (death-censored) at 8 years was 78% for AKI versus 77% for non-AKI grafts. Late proteinuria rates for AKI versus non-AKI recipients with >4 years follow-up were not significantly different. Conclusions. Small pediatric donor AKI impacted early posttransplant kidney graft function, but did not increase risk for early graft loss and decreased long-term function. The presently high nonutilization rates for en bloc kidney grafts from very small pediatric donors with AKI appear therefore unjustified. Based on the outcomes of the present study, we infer that the reluctance to transplant single kidneys from larger pediatric donors with AKI lacks a rational basis as well. Our findings warrant further prospective study and confirmation in larger study cohorts.

Excellent clinical outcomes of renal transplant from pediatric deceased donors with acute kidney injury

“…Jiang et al [ 25 ] found that transplants procured from pediatric AKI donors have a comparable renal function and an excellent patient and graft survival rate, but they found a similar incidence of DGF, which is different from our study. In contrast, our study consists with another study includes very small (≤ 15 kg) pediatric donors with AKI and found that AKI can impact early post-transplant kidney graft function (e.g., the rate of DGF), but it did not increase the risk of early graft loss or decreased renal function in the long term [ 18 ]. A national study of pediatric KT recipients from a donor with AKI found that donor AKI status or increased peak and terminal creatinine levels do not affect the rate of DGF in pediatric KT recipients [ 17 ].…”

“…Several studies have reported worse clinical outcomes when deceased donor kidneys with AKI were used [ 14 , 15 ]. When considering donors, AKI can activate body repair processes and initiate ischemic preconditioning, which can be beneficial for graft function repair in the recipient [ 4 , 16 ], and the kidneys procured from pediatric deceased donors may have greater repair potential because the donors are younger, with fewer underlying disease or comorbidities [ 17 , 18 ]. However, there are scant data and allocation practices on the results of pediatric AKI deceased donor kidney transplantation, and the reliability of pediatric donors with AKI remains controversial [ 17 , 18 ].…”

“…When considering donors, AKI can activate body repair processes and initiate ischemic preconditioning, which can be beneficial for graft function repair in the recipient [ 4 , 16 ], and the kidneys procured from pediatric deceased donors may have greater repair potential because the donors are younger, with fewer underlying disease or comorbidities [ 17 , 18 ]. However, there are scant data and allocation practices on the results of pediatric AKI deceased donor kidney transplantation, and the reliability of pediatric donors with AKI remains controversial [ 17 , 18 ]. Therefore, in this study, we aimed to evaluate the safety and effectiveness of early post-transplantation outcomes in pediatric deceased donors with AKI under various circumstances.…”

Potential of neonatal organ donation and outcome after transplantation

“…Two other studies performed by the same group likely included the same patient population. 79,80 Another study analyzed a series of 30 en block kidney transplantations, comparing outcomes of recipients receiving organs from donors weighing either <5 or >5 kg. 81 The <5-kg group constituted of 8 donors, 7 of whom were in the neonatal period.…”

“…At long‐term follow‐up, no difference in graft survival or function could be observed when comparing DBD with DCD recipients. Two other studies performed by the same group likely included the same patient population 79,80 …”