Graft survival and graft function of pediatric en bloc kidneys in paraaortal position

Abstract

En bloc kidneys show a high percentage of graft survival with excellent long-term graft function. However, the early postoperative period carries a higher risk of graft loss in very young donors due to vascular complications. In the face of donor shortage en bloc kidneys from pediatric donors can successfully be transplanted in a paraaortal position.

Update on En Bloc Renal Transplantation in Pediatric Recipients

“…While early reports of increased vascular complications with en bloc transplantation were discouraging [14][15][16][17], recent reports have shown more encouraging outcomes [4,[18][19][20], further confirmed by our study findings. This is likely due to increased experience and improvements in surgical techniques over time, which should help further reduce the skepticism in using young donor kidneys for transplantation.…”

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).…”

Particle-induced circulatory disturbances in transplanted rhesus macaque kidneys

“…This associates with vascular occlusion and thrombosis in renal allografts in young rhesus monkeys. Given the extensive use of UW solution for organ storage, the potential for particle-induced stress and focal damage at the microanatomical level is most likely to occur in pediatric and infant transplants, known to be especially prone to thrombosis [16]. The potential for preservation solution particle-induced coagulation in small vessels in both experimental and human transplants needs to be carefully scrutinized.…”