Kidney Transplantation from Pediatric Donors in a Single Chinese Center

Abstract

To report clinical outcomes of kidney transplantation from pediatric brain and cardiac death donors (DBCD) in a single Chinese center and to investigate its feasibility to expand organ donor pool. 18 recipients, transplanted between August 2011 and October 2013 in the First Affiliated Hospital of Zhengzhou University, receive a single graft from DBCD donors age ranged from 1.5 to 13 years old. Renal function expressed as serum creatinine, blood urea nitrogen as well as eGFR values at 1, 2 weeks as well as 1-, 3-, 6-, and 12-months post-transplantation was evaluated. Graft size was also monitored at the same time by ultrasonography. In addition, delayed graft function, acute rejection, surgical complication as well as patient and graft survival were also assessed. The primary causes of DBCD donors included six cases of severe brain trauma and three cases of cerebral hemorrhage. The mean age of DBCD donors was (7.2 ± 3.4) years (range 1.5-13). The mean weight of DBCD donors was (29.8 ± 15.3) kilogram (range 13-67). The mean height of DBCD donors was (118.3 ± 27.8) centimeter (range 70-173). ECMO was applied to DBCD donors to avoid warm ischemia time and the applicating time was (79.8 ± 44.5) (range 32-180) minutes.There were seven males and 11 females recipients. Among which, 16 recipients were pediatrics and two recipients were adults. The mean age of the recipients was (14.6 ± 9.7) years (range 4-47). The mean weight of recipients was (31.9 ± 12.4) kilogram (range 11-54). The mean height of recipients was (138.0 ± 23.7) centimeter (range 84-172). Renal function recovered to normal within the first-week post-operation except one recipient which occurred acute rejection. Two cases of renal artery stenosis were found 2-week and 3-month post-transplantation, respectively. They subsequently underwent ballon angioplasty and followed up for 8 and 12 months, respectively, and no recurrence was found. One recipient developed ureteral leak. Five weeks later, the ureter leak healed after adequate drainage and prolongation of indwelling catheter. Graft size significantly and continuously increased during the first year, especially in the first 3-month post-transplantation. All the 18 recipients are alive at the last follow-up. Among which, 16 recipients are followed up for 12 months and 1-year recipient/graft survival rate is 100 %. The use of single kidney graft from pediatric DBCD could yield good short-term results.

Outcomes for primary kidney transplantation from donation after Citizens’ death in China: a single center experience of 367 cases

“…Additional recent studies of clinical outcomes have shown that pediatric DBCD kidney donation for transplant is also feasible [5]. Furthermore, the DBCD program adheres to the guiding principles of the World Health Organization, and is compliant with the Declaration of Istanbul.…”

Single kidney transplantation from pediatric deceased donors in China: the outcomes and risk factors of graft survival

“…However, an imbalance between donors and potential recipients has been aggravated by the rapid growth of ESRD patients on the waiting list, which has outpaced the collection of donor kidneys. Nonetheless, the donor pool had expanded due to an increase in the number of pediatric donors over the past few years (2)(3)(4)(5)(6)(7)(8). This expansion alleviates the conflict between the high demand among ESRD patients and the lack of donor organs.…”

“…A c c o r d i n g t o t h e O r g a n P r o c u r e m e n t a n d Transplantation Network (OPTN) and the Australia and New Zealand Organ Donation Registry (ANZOD), the proportion of pediatric donors has exceeded 10%, and the overall prognosis is also satisfactory (2,(7)(8)(9)(10)(11)(12)(13). Moreover, studies indicated that the prognosis of kidneys from pediatric donors is comparable to or better than that of adult donors (14,15).…”