Small donors for small recipients – excellent growth and long‐term function of single kidney grafts

Abstract

Summary Small‐donor kidneys (≤20 kg donor weight, SDK) are preferably transplanted en bloc in adults. Concerns about thrombotic complications or hyperfiltration hinder their use in children, particularly as single grafts. Low centre experience and donor‐to‐recipient size are rated critical regarding outcomes. We evaluated SDK transplantation (SDTx) in paediatric recipients at a specialized transplant centre. Between 2008 and 2018, SDTx was performed in 40 children (mean age 5.4 ± 1.4 years, single grafts n = 38, donor weight ≤10 kg: n = 10). Perioperative complications were rare (n = 3), mainly thromboses despite immediate heparinization and resulted in graft loss in one patient. Overall, early and long‐term GFR were excellent (76 ± 21 and 100 ± 11 ml/min/1.73 m2, first month and year 5, respectively). Three patients presented with delayed graft function. Graft volume increased significantly (69 ± 38 vs. 111 ± 33 ml within 5 years; P < 0.0001). Patients showed catch‐up growth to normal range (SDS for height −2.06 ± 1.6 to −1.60 ± 1.5). Stratification by recipient age and donor weight revealed superior results in young recipients (≤3 years) and ≤10 kg donors, respectively. Outcome of single SDK grafts was excellent. Gain of GFR and graft volume was even higher in patients with very small donor or recipient size, regardless of a reduced donor‐to‐recipient weight ratio. Therefore, SDTx should be considered favouring small paediatric recipients.

The Outcome of Transplanting Kidneys From Very Small Pediatric Deceased Donors

“…16 The overall thrombosis rate of enrolled patients was 3.6%, which is lower than those in previous studies. 9,22 However, it was still higher than that of adult donors (0.2%–2.4%). 10,47 All thromboses were found within 2 wk posttransplant in our cohort; thus, clinical practice should focus on thrombotic risk stratification and intense follow-up during this period.…”

“…42,43 Efforts have been made to expand the donor pool by using single kidneys from pediatric donors. 9,12,23,24,43,44 Yet, the pediatric donor age and type of transplant have been a subject of discussion to optimize the utilization of donated organs.…”

“…[1][2][3][4][5] Using donated kidneys from deceased pediatric donors improves access to transplantation in children and facilitates size-matching for small recipients. 6,7 Despite concern for potential increased risk of early complications, with some evidence indicating that comparable outcomes could be achieved, [8][9][10] a young for young matching policy has been adopted by some countries worldwide. [9][10][11][12] Graft function is known to adapt to the growth of the recipients over time, and thus, allografts from pediatric donors have potentially a higher long-term estimated glomerular filtration rate (eGFR) than adult donors.…”

“…6,7 Despite concern for potential increased risk of early complications, with some evidence indicating that comparable outcomes could be achieved, [8][9][10] a young for young matching policy has been adopted by some countries worldwide. [9][10][11][12] Graft function is known to adapt to the growth of the recipients over time, and thus, allografts from pediatric donors have potentially a higher long-term estimated glomerular filtration rate (eGFR) than adult donors. 13,14 More families are willing to donate their children's organs if they are preferentially allocated to pediatric recipients in recent years in China.…”

Pediatric Kidney Transplantation: Frameshift in Medical and Surgical Management. Does the Perioperative Setting Have an Impact on Transplant Outcome? A Single-Center Experience

“…For small recipients (below 20 kg) we were accepting smaller donors in era 2 with equally good results. Recently published data support this approach in utilizing small donor kidneys for small recipients ( 11 ). In our study, we found a very big subgroup of patients with HUS as primary diagnosis in era 1 (2008–2013).…”