Donation after Cardiac Death Pediatric En Bloc Renal Transplantation

Dion, Marie; Rowe, Neal; Shum, Jeffrey; Weernink, Corinne; Felbel, Sarah; McAlister, Vivian C.; Şener, Alp; Luke, Patrick

doi:10.1016/j.juro.2014.07.089

Cited by 8 publications

(9 citation statements)

References 18 publications

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“…Pediatric en bloc transplant was performed using previously described techniques . Accordingly, the immunosuppression administered was in accordance to that described in the aforementioned publication.…”

Section: Methodsmentioning

confidence: 99%

Transplantation of pediatric renal allografts from donors less than 10 kg

Mitrou

Aquil

Dion

et al. 2018

American Journal of Transplantation

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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.

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Section: Methodsmentioning

confidence: 99%

Transplantation of pediatric renal allografts from donors less than 10 kg

Mitrou

Aquil

Dion

et al. 2018

American Journal of Transplantation

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“…Dion et al in a recent single-centre analysis identified 21 adult recipients of EBK transplants from paediatric donors under the age of 4 years old, of which four organ pairs were obtained from DCD donors [38]. DGF ensued in 2 of 4 DCD organ recipients and 3 of 17 DBD organs.…”

Section: Use Of Paediatric Dcd Organsmentioning

confidence: 99%

Utilisation of small paediatric donor kidneys for transplantation

et al. 2018

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With the increasing need for kidney transplantation in the paediatric population and changing donor demographics, children without a living donor option will potentially be offered an adult deceased donor transplant of marginal quality. Given the importance of long-term graft survival for paediatric recipients, consideration is now being given to kidneys from small paediatric donors (SPDs). There exist a lack of consensus and a reluctance amongst some centres in transplanting SPDs due to high surgical complication rates, graft loss and concerns regarding low nephron mass and long-term function. The aim of this review is to examine and present the evidence base regarding the transplantation of these organs. The literature in both the paediatric and adult renal transplant fields, as well as recent relevant conference proceedings, is reviewed. We discuss the surgical techniques, long-term graft function and rates of complications following transplantation of SPDs. We compare graft survival of SPDs to adult deceased donors and consider the use of small paediatric donors after circulatory death (DCD) organs. In conclusion, evidence is presented that may refute historically held paradigms regarding the transplantation of SPDs in paediatric recipients, thereby potentially allowing significant expansion of the donor pool.

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“…Using national registry data, good graft outcomes were demonstrated in adult recipients. Historically, the poor outcomes found in the youngest donor kidneys transplanted into young recipients have been attributed to surgical complications, high rates of graft thrombosis, early rejection and hyperfiltration injury [1,7]. Consequently, there has been a reluctance to use the youngest donor kidneys for transplantation into young donors, with a considerable decline in paediatric recipients of young donor kidneys from 7/16 in 1963–1999 to 1/26 in 2000–2018 in our series.…”

Section: Discussionmentioning

confidence: 95%

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

et al. 2020

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Summary Kidneys from very small donors have the potential to significantly expand the donor pool. We describe the collective experience of transplantation using kidneys from donors aged ≤1 year in Australian and New Zealand. The ANZDATA registry was analysed on all deceased donor kidney transplants from donors aged ≤1 year. We compared recipient characteristics and outcomes between 1963–1999 and 2000–2018. From 1963 to 1999, 16 transplants were performed [9 (56%) adults, 7 (44%) children]. Death‐censored graft survival was 50% and 43% at 1 and 5 years, respectively. Patient survival was 90% and 87% at 1 and 5 years, respectively. From 2000 to 2018, 26 transplants were performed [25 (96%) adults, 1 (4%) children]. Mean creatinine was 73 µmol/l ±49.1 at 5 years. Death‐censored graft survival was 85% at 1 and 5 years. Patient survival was 100% at 1 and 5 years. Thrombosis was the cause of graft loss in 12% of recipients in the first era from 1963 to 1999, and 8% of recipients in the second era from 2000 to 2018. We advocate the judicious use of these small paediatric grafts from donors ≤1 year old. Optimal selection of donor and recipients may lead to greater acceptance and success of transplantation from very young donors.

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Donation after Cardiac Death Pediatric En Bloc Renal Transplantation

Abstract: We report successful transplantation of a small cohort of pediatric en bloc kidneys obtained through donation after cardiac death from donors younger than 4 years. Outcomes at 1 year are comparable to those in neurological determination of death en bloc allograft recipients.

Cited by 8 publications

References 18 publications

Transplantation of pediatric renal allografts from donors less than 10 kg

Transplantation of pediatric renal allografts from donors less than 10 kg

Utilisation of small paediatric donor kidneys for transplantation

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

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