Pediatric en bloc kidney transplant from donors <15 kg: An excellent approach to expand the pediatric deceased donor pool

Abstract

IntroductionMost kidneys from small pediatric donors are transplanted to adult recipients because of the perceived risk of surgical complications and graft thrombosis. In this study, we aim to demonstrate our favorable outcomes in transplanting pediatric kidneys from donors &lt;15 k into pediatric recipients.MethodsThis study retrospectively analyzes the outcomes of seven pediatric recipients of en block kidney transplants from pediatric donors weighing &lt;15 kg performed at King Fahad Specialist Hospital‐Dammam from December 2014 to January 2018.Baseline characteristics of donors and recipients were collected. The incidences of surgical complication, immediate, and intermediate graft function were the primary outcomes.ResultsThe study included seven recipients monitored for a mean duration of 6.86 ± 1.35. Donors’ and recipients’ mean weights were 7.4 ± 3.2 kg and 20.7 ± 9.2 kg, respectively. Ureteric stricture occurred in one patient. There was a substantial improvement of 1‐year estimated glomerular filtration rate (eGFR) compared to the 1‐week mark (106.7 ± 26.38 mL/min. 1.73 m2 vs. 63.7 ± 22.92 mL/min/1.73 m2, p = .0069). The observed improvement in renal function persisted at the 5‐year mark and during the last follow‐up, with eGFR of 70.3 ± 40.7 mL/min/1.73 m2, and 79.8 ± 30.8 mL/min/1.73 m2, respectively. There was also increase of 27.9% in the size of the en bloc kidney observed at the 6 months.ConclusionIn a specialized transplant center with highly skilled surgeons, the utilization of en bloc kidney transplant from donors weighing less than 15 kg is an effective strategy for expanding the donor pool and ensuring favorable graft outcomes.