Encouraging outcomes of using a small-donor single graft in pediatric kidney transplantation

Feltran, Luciana de Santis; Genzani, Camila Penteado; Hamamoto, Fernando; Fonseca, Manuel; Camargo, Maria Fernanda Carvalho de; Oliveira, Nara Léia Gelle de; Amaral, Fabio Cabral de Freitas; Baptista, José Carlos; Nogueira, Paulo Roberto

doi:10.1007/s00467-021-05296-1

Cited by 6 publications

(16 citation statements)

References 49 publications

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“…9,22 However, it was still higher than that of adult donors (0.2%-2.4%). 10,47 All thromboses were found within 2 wk posttransplant in our cohort; thus, clinical practice should focus on thrombotic risk stratification and intense follow-up during this period. Another common complication was DGF, which occurred in 39 patients (15.5%) from our cohort.…”

Section: Discussionmentioning

confidence: 83%

“…21,48 Although pediatric kidney transplant recipients from adult donors showed a relatively low incidence of DGF (2.4%–11.1%), this identifies that insufficient functional renal mass at the early stage of transplantation is a possible factor in the development of DGF. 10,49,50 Size mismatch and small vessel size might result in artery stenosis, given the results of lower donor/recipient BWR of patients with artery stenosis and the higher incidence of artery stenosis in the VSPD group of our cohort. Data on pediatric kidney transplants from NPDs showed a relatively low incidence of artery stenosis.…”

Section: Discussionmentioning

confidence: 87%

“…Of note, the overall graft survival rate of our cohort is relatively low compared with some reports but similar to others. [8][9][10]12,24 This is quite possibly due to the cohort consisting predominantly of very young deceased donors and adolescent recipients, which are especially vulnerable to rejection. 42 This could also explain the finding that rejection accounts for the most graft losses in this study.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5] Using donated kidneys from deceased pediatric donors improves access to transplantation in children and facilitates size-matching for small recipients. 6,7 Despite concern for potential increased risk of early complications, with some evidence indicating that comparable outcomes could be achieved, [8][9][10] a young for young matching policy has been adopted by some countries worldwide. [9][10][11][12] Graft function is known to adapt to the growth of the recipients over time, and thus, allografts from pediatric donors have potentially a higher long-term estimated glomerular filtration rate (eGFR) than adult donors.…”

Section: Introductionmentioning

confidence: 99%

“…6,7 Despite concern for potential increased risk of early complications, with some evidence indicating that comparable outcomes could be achieved, [8][9][10] a young for young matching policy has been adopted by some countries worldwide. [9][10][11][12] Graft function is known to adapt to the growth of the recipients over time, and thus, allografts from pediatric donors have potentially a higher long-term estimated glomerular filtration rate (eGFR) than adult donors. 13,14 More families are willing to donate their children's organs if they are preferentially allocated to pediatric recipients in recent years in China.…”

Section: Introductionmentioning

confidence: 99%

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The Outcome of Transplanting Kidneys From Very Small Pediatric Deceased Donors

Zhang

Liu

et al. 2023

Transplantation

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Background. Kidneys from very small pediatric donors (VSPDs, aged <2 y) are underutilized. Concerns regarding potentially inferior outcomes hinder the use in pediatric recipients. Methods. All pediatric kidney-only transplants from <18-year-old donors between January 2012 and May 2021 in our center were included in this study. Outcomes were compared between VSPD and normal pediatric donor (NPD, aged 2–18 y) groups, and 3-y death-censored graft survival was assessed by the multivariable Cox proportional hazard model. Results. Of all 252 enrolled patients, 149 (59.1%) received kidneys from NPDs and 103 (40.9%) from VSPDs. The 3-y graft survival rates of the NPD and VSPD groups were 91.2% and 88.6%, respectively (P = 0.385). The adjusted hazard ratio of 3-y graft loss was 1.2 (95% confidence interval, 0.6-2.5; P = 0.659) for the VSPD group compared with the NPD group. There was no significant difference in estimated glomerular filtration rate at 3 y posttransplant observed between NPD and VSPD groups (86.9 ± 26.8 versus 87 ± 27.9 mL/min/1.73 m2; P = 0.991). Patients (n = 12, 4.8%) who received kidneys from donors <5 kg contributed 5 (5/39, 12.8%) with delayed graft function and the sole primary nonfunction in our cohort. Conclusions. Although attention to preventing complications is necessary, especially for kidneys from donors <5 kg, kidneys from VSPDs did not appear to impart added risk for 3-y graft loss and renal function.

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