Transplanting Pediatric Deceased-Donor Kidneys Into Adult Recipients: An Iranian Experience

Abstract

Objectives: This study sought to evaluate graft outcome of kidneys from deceased-donor pediatric donors in adult recipients, and compare it with outcomes of kidney transplants from adult donors. Materials and Methods: This historical cohort study involved 2 groups. Group 1 included 23 first kidney adult recipients who received their first renal transplant from pediatric deceased-donor donors. Group 2 consisted of 33 first renal transplant adult recipients with kidneys coming from adult deceased donors. The Kaplan-Meier method was used to generate graft survival and patient survival curves. The log-rank test was done to compare differences between survival outcomes. Results: Graft survival rates at 1 and 5 years were 96% and 85% in group 1, and 91% and 85% in group 2. No significant difference existed in graft survival rates between the groups. Patient survival rates at 1 and 5 years in group 1 were 94% and 94% compared with 91% and 91% for group 2. No significant difference existed in graft survival rates between the groups. Conclusions: This study demonstrates that with our experience, improvement in surgical technique and immunosuppressive therapy, pediatric deceaseddonor kidneys may be considered as an alternate option for adult recipients. Renal transplants from pediatric donors into adult recipients is associated with good graft and patient survival outcomes.

Utilisation of small paediatric donor kidneys for transplantation

“…Studies examining outcomes following transplantation using SPDs (with more than 20 recipients) are shown in Table 2 [5, 11–15, 18, 20, 22, 23, 25–28, 30, 31]. In one of the largest studies to date, a US-based registry analysis of 2449 renal transplants from paediatric donors under 20 kg [11], the authors demonstrated a 5-year graft survival rate of 55% for single-organ kidney transplants and 73% for en bloc kidney (EBK) transplants, with a hazard ratio of 0.96 per 1 kg increase in donor weight for graft loss.…”

“…Median 9 years. PS 100%▪ SOK + EBK – 83%Bretan [25]1993–1996400–5 years1-year graft survivalGT rate 2.5%▪ EBK – 100%2-year graft survival▪ EBK – 85%Sui [26]2012–201438< 15 kg1-year graft survivalAll into paediatric recipients▪ All SPD organs – 89%▪ SOK – 96%▪ EBK – 70%Basiri [27]2006–201336Not defined1-year graft survivalGT rate 5.5%▪ EBK + SOK – 90%▪ Adult DD – 92%Hobart [28]1990–199733< 4 years1-year graft survivalGT rate 15%▪ EBK – 87%▪ Adult DD – 84%Mohanka [29]2002–200633< 15 kg1-year graft survivalAll into adult recipients▪ SOK – 86%▪ EBK – 79%Salvatierra [30]1969–1973321–9 years6-month graft survival▪ SOK – 50%Zafarghandi [31]2004–200923< 16 years1-year graft survivalAll into adult recipients▪ EBK + SOK – 96%▪ Adult DD – 91%5-year graft survival▪ EBK + SOK – 85%▪ Adult DD – 85% GS graft survival, GT graft thrombosis, HR hazard ratio, GL graft loss, LD live donor, DD deceased donor, SOK single organ kidney, EBK en bloc kidney, PS patient survival…”