Transplantation of Kidneys from Pediatric Cadaver Donors to Adult Recipients

Abstract

Pediatric donors (less than 12 years old) are a potentially important source of kidneys for adult recipients. Previous reports of decreased graft survival and increased complication rates have made surgeons wary of using such kidneys. In 64 kidneys from younger donors transplanted to adult recipients the delayed graft function rate (41 versus 42%), and 2 and 3-year graft survival rates (67 versus 72% and 61 versus 65%, respectively) were similar to those seen with kidneys from adult donors. Kidneys from donors 24 months old or less experienced an 80% rate of graft loss at 1 year. When these kidneys are excluded the 1-year graft survival rate was similar to kidneys from older and younger donors (70 versus 77%). Mean serum creatinine at 1 year was similar in both groups (155 +/- 21 versus 151 +/- 10). Pediatric kidneys except those obtained from donors 2 years old or less are suitable for adult recipients. However, kidneys from very young donors may be more appropriate to pediatric recipients.

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“…Reports of increased organ discard rates, technical complications, decreased functional nephron reserve, and claims of suboptimal patient and graft survival all have contributed to the reluctance to transplant kidneys from young donors. [2][3][4] In a comprehensive analysis of 203 transplants from donors younger than 5 years from The North American Pediatric Renal Trials and Collaborative Studies database, it was demonstrated that the risk of graft loss when using a neonatal donor was 2.7 times that of an ideal donor (age range, 20-25 years) 5 with 9.9% of grafts lost because of vascular thrombosis.…”

Renal Transplantation From Pediatric Donors in the United Kingdom

“…All of these reservations are surmountable. [11][12][13][14][15][16][17][18][19][20][21][22][23][24] The number of nephrons in each kidney (1.4-3.5 million) is finalized by 36 weeks of gestation. 25 After birth, the growth of the kidney is through hypertrophy determined to some extent the development of creatinine mass of the individual.…”

Transplantation of infant en bloc kidneys into paediatric recipients

“…A high complication rate was reported after EBT in adult recipients, e.g. graft thrombosis, urological problems and early rejection [1,2,3], although graft survival and graft function were favourable [4,5,6,7,8,9]. This high complication rate was observed not only in adults but also in the few paediatric recipients undergoing EBT.…”

“…This imbalance has led to expansion of the criteria for the donor pool, including paediatric donors under the age of 5 years. However, the use of kidney(s) from young paediatric donors, transplanted as singlekidney [1] or as infant en bloc transplantation (EBT) has been controversial discussed [2,3,4,5]. A high complication rate was reported after EBT in adult recipients, e.g.…”