Transplantation of adult‐sized kidneys in low‐weight pediatric recipients achieves short‐term outcomes comparable to size‐matched grafts

Abstract

Goldsmith PJ, Asthana S, Fitzpatrick M, Finlay E, Attia MS, Menon KV, Pollard SG, Ridgway DM, Ahmad N. Transplantation of adult‐sized kidneys in low‐weight pediatric recipients achieves short‐term outcomes comparable to size‐matched grafts. Pediatr Transplantation 2010: 14:919–924. © 2010 John Wiley & Sons A/S. Abstract: Low‐weight pediatric recipients are disadvantaged by scarcity of size‐matched donors. ASK have been successfully used for pediatric recipients. We report the results of renal transplantation using ASK in low‐weight pediatric recipients and compare outcomes in weight‐matched and unmatched donor–recipient pairs. The outcomes of renal transplants using ASK grafts in low‐weight (<20 kg) recipients from a single center over a 10‐yr period were reviewed. Two groups, comprising recipients of grafts from weight‐matched and mismatched donors, were compared. Primary outcome was one‐yr graft survival. Secondary outcomes were one‐ and two‐yr calculated eGFR, changes in recipient body weight, perioperative cardiovascular stability, rates of AR and DGF. Twenty‐three low‐weight recipients were transplanted. Eleven received ASK grafts from high‐weight donors and 12 grafts from low‐weight donors. One patient in each group had early graft loss. No significant difference was observed in rates of DGF, AR, one‐yr graft or patient survival and perioperative cardiovascular parameters. ASK with considerable donor:recipient weight discrepancies can be safely transplanted into small pediatric recipients with comparable outcomes to grafts with less weight discrepancy.

Clinical implication of renal allograft volume to recipient body surface area ratio in pediatric renal transplant

“…Higher resistive indices are seen in children transplanted with an adult kidney which could increase the thrombotic risk or external vascular compression . However, our study is more consistent with recent reports, which did not show any increased risk for surgical‐related complications in pediatric renal transplants even with RAV/rBSA ratio mismatch . Furthermore, some authors have suggested that recent improvements in surgical technique may have prevented related morbidities such as graft loss or vascular complications in pediatric transplantation, especially the allograft placement in small abdominal space or even on the site of anastomosis …”

Donor-Recipient Size Mismatch in Paediatric Renal Transplantation

“…Goldsmith et al [6] described how the scarcity of small paediatric donors required to size match donor and recipient would lead to unacceptably long waiting lists. They conducted a retrospective study between 1999 and 2008 of all paediatric renal transplants performed in their centre in Leeds, UK.…”

“…When applied to children, there are further complications to consider in renal transplantation, ranging from the limited number of potential age-matched donors in developed countries to the relative lack of space in the young paediatric abdominal cavity to accommodate an extra solid organ [6]. …”

Evaluation and Listing of the Infant or Child with Kidney Failure

“…Historically children under the age of 2 have had the highest posttransplant mortality; this statistic, however, has shown recent improvement (Goldsmith et al 2010). In the OPTN/SRTR annual data report for 2012 only 3 of the 2,262 children who received a kidney transplant from 2010 to 2012 were below 1 year of age (OPTN/SRTR 2012).…”