"En bloc" paediatric renal donors into adult recipients - the Newcastle technique

Abstract

Whilst debate still continues about the best use of kidneys from small donors, the techniques used have been varied because of the high vascular thromboses rates and ureteric leak rates. The method described here employs a vessel transposition as described by two German series, but it is combined with an extraperitoneal approach. It is now the method of choice in our unit for such en bloc transplants.

Increasing the donor pool using en bloc pediatric kidneys for transplant

“…Given a growing discrepancy between the number of patients waiting for a kidney and the number of donors, more expanded organs could be used to help reduce the current kidney shortage. There are several ways of expanding the donor pool, including the increased use of kidneys from non-heart-beating donors (10), elderly donors (11), hepatitis C-positive kidneys for hepatitis C-positive recipients (12), and kidneys from pediatric donors (2)(3)(4)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27). The use of kidneys from donors younger than 5 years of age is controversial and has been associated with higher complication rates arising from technical difficulties, graft thrombosis, early rejection, and hyperfiltration injury (17,18,21,25).…”

Successful Transplantation of Kidneys from a Donor with Myoglobinuric Acute Renal Failure

“…To expand the scarce donor pool, alternative sources have been explored. These include widening the live donor pool, usage of pediactric donors, usage of kidneys after cardiac death or older donors and consideration of organs from donors with hypertension, diabetes or other renal diseases, including kidneys from deceased donors with ARF as potential sources (3–7). Although ARF is usually reversible in the living, it is difficult to predict the outcome of the function of such kidneys after transplantation.…”

Outcome of renal transplants from pediatric donors <5 yr of age

“…In transplanting cadaver kidneys from pediatric donors, the standard has been to transplant both kidneys en bloc to one adult recipient. The efficacy and safety of this approach is supported by a large body of research (11–19). However, faced with extreme shortage of organs, transplant teams continue to explore various strategies to expand the donor pool, including single use of such pediatric kidneys.…”