Paediatric en bloc kidney transplantation from a donor less than 5 kg

Abstract

We report a case of the smallest paediatric en bloc kidney (EBK) transplantation in Australia and New Zealand. Dual EBKs were procured from a 4-month-old female donor, corrected age of 5 weeks, with a body weight of 4.2 kg. The donor was diagnosed as brain dead. The recipient was a 43-year-old male with a body weight of 70 kg and a diagnosis of end stage renal failure secondary to reflux nephropathy. The recipient had been on haemodialysis for 50 months with a baseline creatinine of 800-1000 μmol/L and was oliguric. Comorbidities include hypertension and hypercholesterolaemia. Human leukocyte antigen typing yielded five of six mismatches. There was one Class II donor-specific antibody identified with a weak mean fluorescence intensity of 509. T cell and B cell crossmatch was negative. Cold ischaemic time of the kidneys was 16 h due to a long transit time across Australia. Meticulous backtable dissection of the kidneys was performed involving the removal of perinephric fat from both kidneys and skeletonization of the aorta and inferior vena cava. The cephalic ends of the aorta and suprarenal vena cava were oversewn with 6-0 Prolene, Ethicon, Bridgewater, New Jersey. The aorta was spatulated at its bifurcation and both kidneys and vessels were marked with blue ink anteriorly. The kidneys were wrapped in a 'swab sandwich' to prevent torsion during implantation (Fig. 1), a technique described previously. 1 A standard right Rutherford Morrison incision was used for the recipient and the iliac vessels exposed in the extraperitoneal plane. The donor inferior vena cava and aorta were anastomosed to the recipient external iliac vein and external iliac artery, respectively, in an end to side fashion with 6-0 Prolene. The bladder was filled to capacity. Two separate cystotomies were made in the right dome and anterior wall of the