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Raza, S.; Ravula, Phani K; Hakeem, Abdul; Lodge, Peter; Baker, Richard J.; Ahmad, Niaz

doi:10.6002/ect.2013.0062

Cited by 3 publications

(4 citation statements)

References 40 publications

(17 reference statements)

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“…Although there are few reports of back-table EBPK reconstruction and transplantation with good graft function previously published [ 7 , 25 – 27 ], all these reports agree on the crucial role of using a meticulous technique during the vascular reconstruction [ 7 , 25 – 27 ], which, in the light of the results obtained in this case, we also recognize as essential.…”

Section: Discussionsupporting

confidence: 75%

Transplantation of 2-Month-Old En Bloc Pediatric Kidneys After a Complex Vascular Reconstruction – Traveling 2500 Miles to Get Transplanted: A Case Report

et al. 2021

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Patient: Male, 30-year-old Final Diagnosis: End stage renal disease secondary to hypertensive nephropathy Symptoms: Uremic symptoms Medication:— Clinical Procedure: — Specialty: Transplantology Objective: Rare disease Background: En bloc pediatric kidneys (EBPK) are one potential solution to increase the number of organs available in the donor community, thus promoting transplantation of these allografts into adult recipients. However, EBPK transplantation has been traditionally considered suboptimal due to concerns for perioperative complications, mainly vascular thrombosis. We report an en bloc kidney transplantation using vascular grafts from another deceased donor to extend the EBPK aorta and vena cava and create a tension-free anastomosis with recipient external iliac vessels. Case Report: A pair of 2-month-old female en bloc kidneys weighting 6 kg were transplanted to a 30-year-old adult male. Prolonged cold ischemic time (CIT) was related to high refusal rate and long travel from Nevada to Miami. Prior to transplantation, the EBPK were connected to the LifePort Renal Preservation Machine ® and deemed transplantable only after showing a significant improvement in perfusion parameters. Back-table reconstruction was conducted through an end-to-end anastomosis between an adult deceased donor common iliac artery and vein grafts to the inferior vena cava and aortic distal ends, respectively. The patient displayed immediate graft function (IGF) without any postoperative complications, showing a creatinine of 1.5 mg/dl at 4-month follow-up. Conclusions: Use of renal preservation machine (RPM) and refined back-table reconstruction of these allografts are important tools to improve the significant discard rate and improve outcomes of EBPK.

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Section: Discussionsupporting

confidence: 75%

Transplantation of 2-Month-Old En Bloc Pediatric Kidneys After a Complex Vascular Reconstruction – Traveling 2500 Miles to Get Transplanted: A Case Report

et al. 2021

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“…In our knowledge, there are only two similar publications with bigger cohorts, both were mentioned previously (, 13 , 6 ). However, there are also multiple studies in the literature with a smaller number of patients ( 21 , 20 , 19 ). With constantly improving surgical technique and post-transplant management, the lowest limit of DBW for kidney transplantation is not yet clear.…”

Section: Discussionmentioning

confidence: 99%

Donor Size Doesn’t Impact En Bloc Kidney Transplant Outcomes: A Single-Center Experience and Review of Literature

Spaggiari¹,

Petrochenkov²,

Patel³

et al. 2022

Transpl Int

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Few transplant programs use kidneys from donors with body weight (BW)<10 kg due to higher incidence of vascular and urological complications, and DGF. The purpose of this study was to investigate the non-inferiority of pediatric en bloc kidneys from donors with BW<10 kg. We performed a single-center retrospective analysis of en bloc kidney transplants from pediatric donor cohort (n = 46) from 2003 to 2021 and stratified the outcomes by donor BW (small group, donor BW<10 kg, n = 30; standard group, donor BW<10 kg, n = 16). Graft function, rate of early post-transplant complications, graft and patient survival were analyzed. Complication rates were similar between both groups with 1 case of arterial thrombosis in the smaller group. Overall graft and patient survival rates were similar between the small and the standard group (graft survival—90% vs. 100%, p = 0.09; patient survival—96.7 vs. 100%, p = 0.48). Serum creatinine at 1, 3, 5 years was no different between groups. Reoperation rate was higher in the small group (23.3% vs. 6.25%, p = 0.03). The allograft from small donors could be related to higher reoperation rate in the early post-transplant period, but not associated with lower long-term graft and patient survival.

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“…However, few ESRD patients on the waiting list receive a kidney transplant due to the wide gap between potential candidates and organ donors [ 1 ]. En bloc pediatric kidney (EBPK) transplantation represents a potential source to expand the kidney allograft donor pool [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

“…Transplantation of small pediatric kidney allografts (donor age less than 3 years, donor weight less than 15 kg, and kidney size less than 6 cm) has been implemented more frequently over the years, but the increased risk of postoperative vascular and urologic complications, delayed graft function (DGF), or even primary graft nonfunction has made their utilization challenging in both pediatric and adult recipients [ 2 – 4 ]. Additionally, small pediatric renal allografts have been often reported to be damaged during the procurement procedure and their reconstruction and salvage are usually not attempted due to the greater risk of vascular complications [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Complex Vascular Reconstruction of an En Bloc Pediatric Kidney Damaged during Organ Procurement

Riella

Tabbara

Abreu

et al. 2022

Case Reports in Transplantation

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En bloc pediatric kidney (EBPK) allografts are a potential solution to expand the organ donor pool; however, EBPK transplantation has been traditionally considered suboptimal due to concerns of perioperative vascular and urologic complications. Accidental organ or vasculature injury during harvest is not uncommon; however, this does not necessarily mean that the organ should be discarded. Careful vascular reconstruction can be performed using donor vascular grafts, salvaging the organ without stenosis or thrombosis of the vessels. We report an extensive vascular reconstruction of the right renal artery, aorta, and inferior vena cava of a damaged EBPK allograft using a donor pediatric aorta vascular patch with the goal of avoiding postoperative vascular complications.

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Abstract: We report 2 cases of en bloc kidney transplants from young pediatric donors with successful outcomes. We underscore the underuse of this significant donor source, and discuss the factors that may be related to the reasons for reluctance in accepting these kidneys for transplant.

Cited by 3 publications

References 40 publications

Transplantation of 2-Month-Old En Bloc Pediatric Kidneys After a Complex Vascular Reconstruction – Traveling 2500 Miles to Get Transplanted: A Case Report

Transplantation of 2-Month-Old En Bloc Pediatric Kidneys After a Complex Vascular Reconstruction – Traveling 2500 Miles to Get Transplanted: A Case Report

Donor Size Doesn’t Impact En Bloc Kidney Transplant Outcomes: A Single-Center Experience and Review of Literature

Complex Vascular Reconstruction of an En Bloc Pediatric Kidney Damaged during Organ Procurement

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