Survival Benefit of En Bloc Transplantation of Small Pediatric Kidneys in Children

Abstract

Background: En bloc transplantation of small pediatric kidneys in children may help expand the existing deceased donor pool; however, studies examining the long-term outcomes of en bloc transplantation in children are few.Methods: We used the Scientific Registry of Transplant Recipients to identify 149 pediatric en bloc recipients transplanted from 10/1/1987-12/31/2017. We used propensity scores to match 148 en bloc with 581 non-en bloc deceased donor recipients (matching variables: transplant age, gender, race, pretransplant dialysis, transplant center and year). We evaluated patient and graft survival using Kaplan-Meier and Fleming-Harrington weighted log-rank test, and examined survival benefit of en bloc transplantation versus remaining on the waitinglist using the sequential Cox approach. We divided the study period into three 10-year intervals to assess the effect of era on outcomes.Results: Compared with non-en bloc recipients, en bloc recipients had lower 1-year graft survival (78.9% vs. 88.9; p 0.007), however when stratified by transplant era, lower 1-year survival was only observed in the oldest era (1987)(1988)(1989)(1990)(1991)(1992)(1993)(1994)(1995)(1996)(1997). En bloc recipients had superior 10-year patient

Paediatric kidney transplants from donors aged 1 year and under: an analysis of the Australian and New Zealand Dialysis and Transplant Registry from 1963 to 2018

“…Kizilbash et al . [8] found that recipients of paediatric en bloc transplants had superior 10 year patient (89% vs. 80%; P : 0.04) and graft survival (52% vs. 40%; P : 0.04) compared with matched nonen bloc recipients. After multivariate adjustment, en bloc transplantation was associated with superior patient survival compared to remaining on the wait list (aHR 0.58; 95% CI 0.36–0.95; P : 0.03).…”

“…Kizilbash et al . [8] demonstrated that the higher risk of graft loss due to thrombosis during the first year post‐transplant amongst en bloc recipients was only seen in the earliest era of their study from 1987 to 1997. From 1998 to 2017, there was no difference in 1‐year graft survival between en bloc and standard criteria donor kidney recipients.…”

Strategies to Expand the Deceased Donor Pool for Pediatric Kidney Transplant Recipients

“…We also found a survival benefit for SPD en bloc transplantation compared with remaining on the waiting list (adjusted hazard ratio, 0.58; P50.03). Stratified analysis showed that 1-year graft survival was lower in en bloc recipients transplanted during 1987-1997 but was similar thereafter (10). Other recent pediatric studies have also shown favorable graft survival in pediatric en bloc SPD recipients (11).…”

“…SPDs currently receive high KDPI scores (median KDPI, 72%) (10) and this scoring should be considered for revision because a high KDPI score results in these kidneys being considered primarily for adults. Based on the data discussed above, we advocate increased allocation of SPDs to children.…”

Perioperative anesthesia care for the pediatric patient undergoing a kidney transplantation: An educational review

“…These small kidneys are often transplanted “en bloc”: two kidneys along with a part of the donor aorta and vena cava. Having the potential to grow along with a growing recipient, small pediatric kidneys show a good long‐term outcome when transplanted in older children or adult recipients 5 . However, in small pediatric recipients, this procedure shows a high incidence of vascular complications.…”