Kidney Transplantation in Small Children: Association Between Body Weight and Outcome—A Report From the ESPN/ERA-EDTA Registry

Abstract

Background. Many centers accept a minimum body weight of 10 kg as threshold for kidney transplantation (Tx) in children. As solid evidence for clinical outcomes in multinational studies is lacking, we evaluated practices and outcomes in European children weighing below 10 kg at Tx. Methods. Data were obtained from the European Society of Paediatric Nephrology/European Renal Association and European Dialysis and Transplant Association Registry on all children who started kidney replacement therapy at <2.5 y of age and received a Tx between 2000 and 2016. Weight at Tx was categorized (<10 versus ≥10 kg) and Cox regression analysis was used to evaluate its association with graft survival. Results. One hundred of the 601 children received a Tx below a weight of 10 kg during the study period. Primary renal disease groups were equal, but Tx <10 kg patients had lower pre-Tx weight gain per year (0.2 versus 2.1 kg; P < 0.001) and had a higher preemptive Tx rate (23% versus 7%; P < 0.001). No differences were found for posttransplant estimated glomerular filtration rates trajectories (P = 0.23). The graft failure risk was higher in Tx <10 kg patients at 1 y (graft survival: 90% versus 95%; hazard ratio, 3.84; 95% confidence interval, 1.24-11.84), but not at 5 y (hazard ratio, 1.71; 95% confidence interval, 0.68-4.30). Conclusions. Despite a lower 1-y graft survival rate, graft function, and survival at 5 y were identical in Tx <10 kg patients when compared with Tx ≥10 kg patients. Our results suggest that early transplantation should be offered to a carefully selected group of patients weighing <10 kg.

Changes in graft outcomes in recipients <10 kg over 25 years of pediatric kidney transplantation in the United States

“…Boehm et al. compared outcomes in European children between 2000 and 2016 and identified a significant lower 1‐year graft survival of 90% in children <10 kg compared to 95% in children ≥10 kg 20 . However, 5‐year graft survival was comparable.…”

Non-contrast-enhanced magnetic resonance angiography as part of a kidney pretransplantation work-up in a 19-month-old boy – a case report

“…In comparison to adults, KT in children is characterized by a unique approach, mainly due to the different etiology of CKD, specificity of developmental age and smaller recipients' body size. KT is usually performed at a minimal recipient weight of 10 kg but it may be considered below this threshold in selected cases [6]. Nevertheless, KT in such patients may be technically challenging for anatomical reasons, including small vessel sizes, making the creation of sufficient vascular anastomoses with renal graft problematic.…”

Kidney Transplantation in ≤15 kg Children: Outcomes and Prognostic Indicators—A Review of the Organ Procurement and Transplantation Database

“…Despite these challenges, the patient and graft survival for recipients ≤15 kg has been excellent in the modern era. Multiple studies comparing kidney transplants in recipients ≤15 kg versus those >15 kg found no difference in outcomes related to patient and graft survival [5][6][7][8]. Other studies have shown that it is possible to achieve >80% graft survival up to 10 years posttransplant even in this high-risk populace [9].…”