Outcome of renal transplants from pediatric donors <5 yr of age

Abstract

Pediatric donor kidneys transplanted individually provide for equal patient and graft survival when compared with en bloc transplants. TRL can be used reduce the detrimental effect of acute rejection on graft growth and function when compared with CyA. Single use of such kidneys can safely and efficaciously be transplanted into adult recipients, greatly expanding the donor pool.

Glomerulopathy in Adult Recipients of Pediatric Kidneys

“…This favorable clinical outcome can be observed for long post-transplantation periods, as described in a series with 5-9 years follow-up [6] and even with a 20-year follow-up [7]. Furthermore, the transplantation of a single PDK into adult recipients has also been shown to be clinically successful [8]. Al-Bader et al [9] described that the survival of single PDK into adults after 6 months and after 3 years was similar to that of adult-donor kidney (ADK) grafts.…”

Single Versus En Bloc Kidney Transplantation From Pediatric Donors Less Than or Equal to 15 kg

“…Although the en bloc concept evolved in part to avoid technical complications believed to be inherent in handling small pediatric renal vessels we believe that single pediatric kidney transplantation is safe as long as an aortic patch is present. El-Sabrout et al suggested that the use of SKs (vs. en bloc) reduces the likelihood of vascular torsion, and a wide aortic carrel patch avoids the risk of anastomotic stricture or occlusion (20). In contrast, Merkel et al (19) suggest that the en bloc technique results in a higher percentage or recipients with retained graft function, especially when one of the pair of kidneys is injured.…”

Surgical illustration of en-bloc (dual) kidney transplant from a 16-month old brain-dead donor to an adult recipient

“…Pediatric kidneys were first transplanted to an adult recipient using en-bloc kidney technique (EBKT) in 1972,[3] and later in 1990, single paediatric kidney transplant (SPKT) in adult was done successfully. [4] While some authors favor single paediatric kidney transplant (SPKT) in view of technical ease and benefiting two recipients,[5] others support EBKT to decrease the chances of hyperfiltration injury and vascular complications. [67]…”