Single<i>vs</i>dual (<i>en bloc</i>) kidney transplants from donors ≤ 5 years of age: A single center experience

Al-Shraideh, Yousef; Farooq, Umar; El‐Hennawy, Hany; Farney, Alan C.; Palanisamy, A.; Rogers, Jeffrey; Orlando, Giuseppe; Khan, Muhammad Arsalan; Reeves‐Daniel, Amber; Doares, William; Kaczmorski, Scott; Gautreaux, Michael D.; Iskandar, Samy S.; Hairston, Gloria; Brim, Elizabeth; Mangus, Margaret; Stratta, Robert J.

doi:10.5500/wjt.v6.i1.239

Cited by 19 publications

(21 citation statements)

References 51 publications

(50 reference statements)

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“…EB transplantation facilitates the completion of the vascular anastomoses compared to SK transplants from small pediatric donors . Transplanting a SK from a small pediatric donor anastomoses small donor vessels to small recipient vessels, in relatively hypotensive patients (compared to adult recipients), which may result in early technical failure . In the United States, approximately 3% of pediatric first‐time renal transplant recipients are already sensitized with PRA >80%, due to prior exposure to blood transfusions or other organ transplants.…”

Section: Discussionmentioning

confidence: 99%

Very small pediatric donor kidney transplantation in pediatric recipients

Yaffe

Friedmann

Kayler

2017

Pediatric Transplantation

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Kidneys from very small pediatric donors (age <5 years, weight <21 kg) may be a means to increase the donor pool for pediatric recipients. Transplantation of small pediatric kidneys is more commonly performed in adult recipients due to the increased risks of technical complications, thrombosis, and early graft failure. While these risks are abrogated in adult recipients by limiting the donor weight to ≥10 kg and using the EB technique, it is unknown whether pediatric recipients achieve comparable results. US national data were assessed for all first-time, deceased-donor, kidney-only pediatric recipients, 1/1996-10/2013, who received very small pediatric donor grafts or grafts from ideal adult donors. We identified 57 pediatric EB, 110 pediatric SK, and 2350 adult transplants. The primary outcome was 3-year all-cause graft survival. Kaplan-Meier curves showed worse outcomes for pediatric grafts compared to adult ideal grafts (P=.042). On multivariate analysis, pediatric recipients of SK grafts had significantly higher HRs (aHR 2.01, 95% CI 1.34-3.00) and pediatric recipients of EB grafts had somewhat higher non-significant HRs (1.57; 95% CI 0.88-2.79) for graft survival. These results suggest cautionary use of very small pediatric donors as a source to expand the donor pool for pediatric candidates.

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Section: Discussionmentioning

confidence: 99%

Very small pediatric donor kidney transplantation in pediatric recipients

Yaffe

Friedmann

Kayler

2017

Pediatric Transplantation

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“…Bhayana et al 9 described that 5-year survival in adult recipients of kidneys from 0- to 5-year-old donors was comparable between en bloc and single-kidney transplants; however, 10-year graft survival was better with en bloc than with single-kidney transplants. Al-Shraideh et al 11 reported that 60-month graft survival was better with en bloc than with single-kidney transplants in adults receiving kidneys from 5-year-old or younger donors.…”

Section: Discussionmentioning

confidence: 99%

“…4-11 In terms of size-mismatch kidney transplantation from very young and small donors to adult recipients, some studies have recommended that the choice between en bloc and single-kidney transplantation be based on donor age, 24-26 donor weight, 10 or relative size of the donor and recipient. 27,28 Hidden behind the age-based recommendations may be the podocyte maturational level of donor kidneys.…”

Section: Discussionmentioning

confidence: 99%

“…3 Recent single-center and multicenter series have reported long-term graft survival or function of en bloc pediatric donor kidneys either comparable or superior to single-kidney transplants or living adult donor kidneys. 4-11 Favorable outcomes of en bloc pediatric donor kidney transplantation are attributed primarily to grafting of a larger renal volume and twice the nephron mass of a single kidney.…”

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confidence: 99%

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En Bloc Cadaver Kidney Transplantation From a 9-Month-Old Donor to an Adult Recipient: Maturation of Glomerular Size and Podocyte in the Recipient

Hirukawa

Suzuki

Niimura

et al. 2017

Transplantation Direct

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BackgroundFavorable outcomes of en bloc pediatric donor kidney transplantation to adult recipients are attributed primarily to grafting of twice the nephron mass of a single kidney.MethodsThe kidneys of a 9-month-old male infant were transplanted en bloc in a 56-year-old man. Biopsies were performed 1 hour postreperfusion, 6 months and 3.5 years posttransplant.ResultsWarm and cold ischemia times were 21 and 426 minutes, respectively. The recipient was released from hemodialysis 10 days posttransplant and discharged 91 days posttransplant when serum creatinine was 0.9 mg/dL. At 4 years and 9 months posttransplant, serum creatinine was 1.0 mg/dL, and estimated glomerular filtration rate was 58.0 mL/min per 1.73 m2. The grafts increased in size until they reached adult size by 3 months posttransplant. The glomerular area and volume, respectively, increased from 5.9 × 103 μm2 and 0.34 × 106 μm3 at 1 hour postreperfusion to 14.9 × 103 μm2 and 1.27 × 106 μm3 at 3.5 years posttransplant, both of which were less than half of adult size. At 1 hour postreperfusion, podocytes were structurally immature. At 6 months posttransplant, podocyte immaturity was still evident. At 3.5 years posttransplant, podocytes were mature.ConclusionsThese findings suggest that podocytes and glomerular size of pediatric donor kidneys can continue to mature in adult recipients at rates appropriate for donor age when transplanted en bloc. The maturational levels of podocytes and glomeruli may also be a factor involved in favorable outcomes of en bloc pediatric donor kidney transplantation.

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“…In the aforementioned study of Kayler et al, they reported that the outcomes of SKT of donor 10‐34 kg are similar to non‐ideal standard deceased donor and underlined that SKT provides more cumulative graft years. Mohanka et al showed that there is no difference in 1‐year graft survival between SKT and EBKT for donor less than 15 kg in adult recipients (79% vs 86%, P = 1.000), and Al‐Shraideh et al reported similar results for donor younger than 5 years 16,17 . In pediatric recipients, Sui et al compared the outcomes of SKT with donors 5‐15 kg and EBKT with donors 2.5‐5 kg 18 .…”

Section: Discussionmentioning

confidence: 99%

Single versus en bloc kidney transplant from donors less than or equal to 15 kg to pediatric recipients

Chung

et al. 2020

Pediatric Transplantation

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With small kidneys, EBKTs could provide sufficient renal mass but could lead to inefficient use of resources, while SKTs could result in insufficient function due to small renal mass. We aimed to compare the outcomes of EBKT and SKT from small donors weighing ≤15 kg to pediatric recipients. We retrospectively reviewed all pediatric patients who met the inclusion criteria between January 1, 1984, and April 30, 2019, at a single institution. Of a total of 23 patients, 12 received EBKT and 11 received SKT. The median age of donors, weight of donors, and weight of recipients were comparable between the two groups. The median age of recipients and median weight of allografts were greater in the EBKT group than in the SKT group. The median follow‐up was 53.9 months. There was no significant difference in eGFR, protein creatinine ratios at 1‐year follow‐up, and overall graft survival. The size of the kidney increased by approximately 13%‐43% in the EBKT group and 40%‐60% in the SKT group. This study demonstrated that kidneys from small donors weighing 5‐15 kg could be split in pediatric recipients without compromising the outcome.

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

Abstract: AIM:To compare outcomes between single and dual en bloc (EB) kidney transplants (KT) from small pediatric donors. METHODS:Monocentric nonprospective review of KTs from pediatric donors ≤ 5 years of age. Dual EB KT was defined as keeping both donor kidneys attached to

Cited by 19 publications

References 51 publications

Very small pediatric donor kidney transplantation in pediatric recipients

Very small pediatric donor kidney transplantation in pediatric recipients

En Bloc Cadaver Kidney Transplantation From a 9-Month-Old Donor to an Adult Recipient: Maturation of Glomerular Size and Podocyte in the Recipient

Single versus en bloc kidney transplant from donors less than or equal to 15 kg to pediatric recipients

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