The Outcome of Transplanting Kidneys From Very Small Pediatric Deceased Donors

Abstract

Background. Kidneys from very small pediatric donors (VSPDs, aged <2 y) are underutilized. Concerns regarding potentially inferior outcomes hinder the use in pediatric recipients. Methods. All pediatric kidney-only transplants from <18-year-old donors between January 2012 and May 2021 in our center were included in this study. Outcomes were compared between VSPD and normal pediatric donor (NPD, aged 2–18 y) groups, and 3-y death-censored graft survival was assessed by the multivariable Cox proportional hazard model. Results. Of all 252 enrolled patients, 149 (59.1%) received kidneys from NPDs and 103 (40.9%) from VSPDs. The 3-y graft survival rates of the NPD and VSPD groups were 91.2% and 88.6%, respectively (P = 0.385). The adjusted hazard ratio of 3-y graft loss was 1.2 (95% confidence interval, 0.6-2.5; P = 0.659) for the VSPD group compared with the NPD group. There was no significant difference in estimated glomerular filtration rate at 3 y posttransplant observed between NPD and VSPD groups (86.9 ± 26.8 versus 87 ± 27.9 mL/min/1.73 m2; P = 0.991). Patients (n = 12, 4.8%) who received kidneys from donors <5 kg contributed 5 (5/39, 12.8%) with delayed graft function and the sole primary nonfunction in our cohort. Conclusions. Although attention to preventing complications is necessary, especially for kidneys from donors <5 kg, kidneys from VSPDs did not appear to impart added risk for 3-y graft loss and renal function.

Favorable Outcome After Single-kidney Transplantation From Small Donors in Children: A Match-controlled CERTAIN Registry Study

“…19,22 Recently, a large single-center study reported on the outcome of mainly single-kidney pediatric KTx from 103 donors <2 y versus 149 donors 2–18 y and found excellent graft survival and similar GFR at 3 y. 16 However, because of the single-center design and donor-recipient size matching protocol, small donor recipients were considerably smaller (15%), potentially leading to overestimation of eGFR in this group. In our study, we found that SDKTx recipients had a superior eGFR at 3 and 5 y than ADKTx recipients, even when performed as single SDKTx.…”

“…10 In contrast to these registry studies, numerous single-center studies have reported excellent outcomes of SDKTx in pediatric recipients, even after a single KTx from very small donors. [11][12][13][14][15][16] Although these studies usually provide more detailed clinical data than registry studies, their generalizability is limited by the lack of a control group and the inherent risk of publication bias.…”

Outcomes in pediatric recipients of single kidney transplantation from pediatric donors with acute kidney injury: A single-center pilot study

“…The process used to recover the pediatric donor kidneys, the back-table preparation method, and the transplant procedures were described in a previous study. [ 4 ] En bloc kidney transplantation was exclusively considered for donors with a body weight less than 5 kg. Graft loss was defined as the irreversible failure of the transplanted kidney, indicated by the need for long-term dialysis, addition to the list for a subsequent kidney transplant, or retransplantation.…”