Transplantation of pediatric renal allografts from donors less than 10 kg

Abstract

Few transplant programs use kidneys from donors with body weight (BW) < 10 kg. We hypothesized that pediatric en bloc transplants from donors with BW < 10 kg would provide similar transplant outcomes to larger grafts. All pediatric en bloc renal transplants performed at our center between 2001 and 2017 were reviewed (N = 28). Data were stratified by smaller (donor BW < 10 kg; n = 11) or larger donors (BW > 10 kg; n = 17). Renal volume was assessed during follow-up with ultrasound. Demographic characteristics were similar between the 2 groups of recipients. After mean follow-up of 44 months (smaller donors) and 124 months (larger donors), graft and patient outcomes were similar between groups. Serum creatinine at 1, 3, and 5 years was no different between groups. At 1 day posttransplant, mean total renal volume in the smaller donors was 28 ± 9 mm vs 45 ± 12 mm (P < .01). By 3 weeks, it was 53 ± 19 mm (smaller donors) versus 73 ± 19 mm (larger donors) (P = NS). Complication rates were similar between both groups with 1 case of venous thrombosis in the smaller group. With experience, outcomes are equivalent to those from larger pediatric donors.

Urologic complications after transplantation of 225 en bloc kidneys from small pediatric donors ≤20 kg: Incidence, management, and impact on graft survival

“…Fortunately, these complications affected neither graft nor patient survival. Our urologic complication incidence is thus in line with the aforementioned report of an 11% overall rate after 28 EBKs, and a 27% rate for the EBKs from 11 donors <10 kg in the same series . Our findings also suggest that ureteral complications would be expected to occur about twice as frequently after EBK than after adult donor kidney transplantation.…”

“…We also observed the previously reported extremely favorable long-term post-EBK results, with low rates of late vascular complications such as graft artery stenosis, and a graft survival that meets or even exceeds long-term outcomes observed with standard criteria grafts from adult deceased or older live donors. 4,5,19,31,32 Our observations have several important clinical and pro- (2) the contribution, if any, of cold ischemia time to our results (as preservation times were very long for nearly all grafts); and (3) the impact of the imported vs local origin of the grafts (as nearly all grafts had been imported). Additionally, we did not assess the implication of ureteral complications using a bladder patch in our patient population, as most of our grafts were recovered at different centers, and there was no way to direct the recovery surgeons to do so even if this had been desired.…”

“…Second, the ureteral complications may be associated with the long cold ischemic times observed in our study (median cold ischemic time was >25 hours in the study and control group). It is interesting to note, however, that cold ischemia time has not been identified as a risk factor for urologic complications in any of the previously published studies in recipients of adult and pediatric deceased donor kidneys . Also, formal study of the potential impact of (shorter) cold ischemia time impact would presently not be possible.…”

“…That study was, however, focused on functional short‐ and long‐term outcomes and graft survival; urologic complications were not defined . Mitrou et al reported an 11% overall urologic complication rate after 28 EBKs (that study's population also included several larger [>3 years old] en bloc donors and did not define urologic complications, either). A UK registry analysis of graft loss causes after 56 EBKs reported no losses from urologic complications, but it remains unclear whether this graft loss cause was even considered as a separate category .…”

“…It is interesting to note, however, that cold ischemia time has not been identified as a risk factor for urologic complications in any of the previously published studies in recipients of adult and pediatric deceased donor kidneys. [10][11][12]17,19,21 Also, formal study of the potential impact of (shorter) cold ischemia time impact would presently not be possible. Such a study would require performance of many more EBKs using local donors in order to generate cases with short preservation times, but only a few transplant centers are performing EBKs from very small pediatric donors.…”