Pediatric en bloc kidney transplantation from very small (≤10 kg) donation after circulatory death (versus brain death) donors: Single-center matched-pair analysis of 130 transplants

Abstract

En bloc kidney transplants (EBK) from very small pediatric donation after circulatory death (DCD) donors are infrequent because of the perception that DCD adversely impacts outcomes. We retrospectively studied 130 EBKs from donors ≤10 kg (65 consecutive DCD vs 65 donation after brain death [DBD] transplants; pair-matched for donor weight and terminal creatinine, and for preservation time). For DCD vs DBD, median donor weight was 5.0 vs 5.0 kg; median recipient age was 57 vs 48 years (P = .006). Graft losses from thrombosis (DCD, 5%; DBD, 7%) or primary nonfunction (DCD, 3%; DBD, 0%) were similar in both groups (P = .7). Delayed graft function rate was higher for DCD (25%) vs DBD (14%) (P = .2). Graft survival (death-censored) for DCD vs DBD at 5 years was 87% vs 91% (P = .3). Median estimated GFR (mL/min per 1.73 m ) was significantly lower for DCD recipients at 1 and 3 months; at 6 years it remained stable at 100 (DCD) and 99 (DBD). DCD impacted early posttransplant graft function, but did not appear to impart added risk for graft loss and long-term function. Very small (≤10 kg) DCD EBK donors should be considered as an option to augment the deceased kidney donor pool; larger studies with longer follow-up must confirm these findings.

Renal transplant from infant and neonatal donors is a feasible option for the treatment of end-stage renal disease but is associated with increased early graft loss

“…The main limitation of this study is the small cohort size, yet this is the largest reported single‐center series of EKT from donors weighing less than 5 kg, including neonatal donors outside the United States . This study includes the previously reported cases by the author .…”

“…The same group also reported a higher risk (10 of 52) of graft thrombosis in EKTs from donors <5 kg compared to ≥5 kg donor EKT (7 of 140) . Their single‐center series of EKTs from 65 paired donation after cardiac death (DCD) and donation after brain death (DBD) donors under 10 kg reported recently states 1‐ and 5‐year death censored graft survival of 89% and 87%, respectively, for DCD grafts and 91% for DBD grafts at 1 and 5 years …”

Urologic complications after transplantation of 225 en bloc kidneys from small pediatric donors ≤20 kg: Incidence, management, and impact on graft survival

“…Recipients for the en bloc grafts in this analysis were selected according to previously described criteria . With respect to the urinary outflow tract, these criteria included inasmuch as possible preserved urine output (and thus preserved bladder size) in order to maximize likelihood of a tension‐free ureteroneocystostomy.…”

Non‐standard criteria donors in pediatric kidney transplantation

“…Data from the United States evaluating outcomes from donors under 10 kg, and comparing DBD vs DCD, also show comparable results, concluding that DCD impacted early post‐transplant graft function, but did not appear to impart added risk for graft loss or long‐term function. Therefore, very small en bloc kidney donors should be considered as an option to augment the deceased kidney donor pool …”

“…Data from the United States evaluating outcomes from donors under 10 kg, and comparing DBD vs DCD, also show comparable results, concluding that DCD impacted early post-transplant graft function, but did not appear to impart added risk for graft loss or longterm function. Therefore, very small en bloc kidney donors should be considered as an option to augment the deceased kidney donor pool 65. Patients with current non-CNS tumors are usually excluded for donation (except for cervical carcinoma in situ and non-melanoma skin tumors), while donors with a history of non-CNS tumors are accepted if curative therapy has been successfully performed 10 years prior to donation (except for breast cancer/melanoma).…”