Kidney transplantation outcomes for adult recipients of pediatric donor kidneys

Arshad, Adam; Hodson, James; Chappelow, Imogen; Nath, Jay; Sharif, Adnan

doi:10.1111/petr.13767

Cited by 2 publications

(5 citation statements)

References 22 publications

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“…The second challenge in our cases was the fact the organs were procured separately, though we did not have the chance to decide to transplant them as single or dual grafts. Since single kidneys of this age group also show very good long‐term results, 3,5,12 this was not a contraindication for our decision.…”

Section: Discussionmentioning

confidence: 91%

“…Our transplant center has no pediatric transplant program. Due to the experience of one of the authors (MK) with pediatric KTx and the convincing data that pediatric kidney grafts can safely be transplanted into adults, 2,3,5 we decided to accept the organs despite the fact that no other center in the ET area had accepted them, most likely because of the established anuric AKI.…”

Section: Discussionmentioning

confidence: 99%

“…While it has been shown that pediatric grafts, in general, can be transplanted into adult recipients with good long‐term results, 5 data on small pediatric grafts with acute kidney injury (AKI) are rare and unavailable for acute anuric renal failure. We assumed infant kidneys to be free of chronic structural changes and therefore have a high regenerative potential and we selected recipients without severe comorbidities, who were expected to be able to tolerate delayed graft function (DGF).…”

Section: Introductionmentioning

confidence: 99%

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Successful transplantation of four kidney grafts from two small pediatric donors with anuric acute renal failure into adult recipients

Koch

Kraus

Boedecker

et al. 2023

Pediatric Transplantation

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Background: Kidneys from infants with anuric acute kidney injury (AKI) only rarely get accepted for transplantation despite encouraging data that such kidneys can have very good long-term outcome. Methods:We report the transplantation of four kidney grafts from two pediatric donors (3 and 4 years) with anuric acute kidney injury as single kidneys into four adult recipients.Results: All grafts gained function within 14 days posttransplantation, only one recipient needed dialysis after transplantation. None of the recipients suffered from surgical complications. One month after transplantation, all recipients were free of dialysis. Estimated glomerular filtration rates (eGFR) 3 months after transplantation were 37, 40, 50, and 83 mL/min/1.73 m 2 . eGFR increased further through month 6, reaching 45, 50, 58, and 89 mL/min/1.73 m 2 . Conclusion:These cases highlight the feasibility of successful transplantation of single pediatric kidney grafts into adult recipients despite anuric AKI of the donor.

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Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Successful transplantation of four kidney grafts from two small pediatric donors with anuric acute renal failure into adult recipients

Koch

Kraus

Boedecker

et al. 2023

Pediatric Transplantation

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“…in both children and adults in transplant studies (12). Kidneys also appear to be the organ that suffers the most injury from excessive exposure to NS, with data suggesting this is due to the chloride load (13).…”

mentioning

confidence: 98%

“…It is notable that, while we are staunch believers of the adage that children are not simply small adults, this wisdom may not apply in this particular scenario. Kidneys, after all, have been shown to be functionally equivalent organs in both children and adults in transplant studies (12). Kidneys also appear to be the organ that suffers the most injury from excessive exposure to NS, with data suggesting this is due to the chloride load (13).…”

mentioning

confidence: 99%

Running Wide Open: Strong Evidence for Bolus Fluids Selection in Pediatric Sepsis*

Palmer,

Agus

2023

Critical Care Medicine

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crutinizing long-established practices in medicine is foundational to the culture of continuous improvement, yet requires surprising amounts of energy, diligence, and commitment. IV fluid (IVF) administration, both as a bolus dose to restore compromised circulatory volume, and as maintenance IVF, seem particularly prone to this type of clinical inertia. Although this is true across medicine (1), pediatricians are often forced to make decisions with smaller trials, and use more indirect evidence, generally from adult trials. Data from 1992 were cited as the turning point that informed the 2018 guidelines from the American Academy of Pediatrics which changed the Academy's guidance on maintenance IVF from hypotonic fluids to isotonic fluids for risk of hyponatremia development (2, 3).Similarly, the choice of bolus fluids in the early management of sepsis is an area of historical controversy in both adult and pediatric practice, where normal saline (NS) has long been the preferred agent. Despite emerging data that balanced crystalloid (BC) fluids with more physiologic concentrations of sodium, potassium, and chloride were safe (4-8), multiple myths persisted about the potassium content causing hyperkalemia and sodium lactate precipitating lactic acidosis and interfering with lactic acid measurements (5, 9-11).In reality, there is no evidenced-based advantage of NS over BC in bolus IVF administration. In fact, a modern IVF researcher with a clean slate, tasked with designing a resuscitation fluid, would doubtless constitute a fluid with physiologic tonicity (BC) not hypertonicity (NS), physiologic chloride concentration (BC) not hyperchloremia (NS), and physiologic pH (BC) not acidic fluid (NS).Beyond academic thought experiments, there exists published data systematically supporting the use of BC as a bolus fluid in the critically ill adult population. Potura et al (4) showed that patients receiving BC had less hyperchloremia, acidosis, and required less vasopressor support. Weinberg et al (5) showed patients receiving NS were more likely to develop hyperkalemia, hyperchloremia, and metabolic acidosis. Semler et al (8) in the groundbreaking Isotonic Solutions and Major Adverse Renal Events Trial (SMART) trial, took these findings further, demonstrating adverse clinical outcomes attributable to NS bolus administration: in critically ill adults, receiving BC was associated with a lower rate of the composite outcome of death, new renal replacement therapy (RRT), or persistent renal dysfunction. This trial enrolled over 15,000 patients in a multicenter, double-blinded randomized clinical trial (RCT) that rapidly changed fluid administration practices for critically ill adult patients.It is notable that, while we are staunch believers of the adage that children are not simply small adults, this wisdom may not apply in this particular scenario. Kidneys, after all, have been shown to be functionally equivalent organs *See also p. 1449.

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Kidney transplantation outcomes for adult recipients of pediatric donor kidneys

Cited by 2 publications

References 22 publications

Successful transplantation of four kidney grafts from two small pediatric donors with anuric acute renal failure into adult recipients

Successful transplantation of four kidney grafts from two small pediatric donors with anuric acute renal failure into adult recipients

Running Wide Open: Strong Evidence for Bolus Fluids Selection in Pediatric Sepsis*

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