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

Fananapazir, Ghaneh; Tse, Gary; Geronimo, R. Di; McVicar, John P.; Perez, Richard V; Santhanakrishnan, Chandrasekar; Sageshima, Junichiro; Troppmann, Christoph

doi:10.1111/ajt.15792

Cited by 9 publications

(9 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…[23], which may be related to the larger dimension of vessels owing to higher donor age and weight. Urological complications, such as ureteral stenosis or leakage, were of minor importance in our study as well in recently published larger cohorts [30,31].…”

Section: Discussionsupporting

confidence: 75%

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

Cetiner¹,

Paul

Treckmann

et al. 2021

Transplant International

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionsupporting

confidence: 75%

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

Cetiner¹,

Paul

Treckmann

et al. 2021

Transplant International

View full text Add to dashboard Cite

show abstract

“…Stricture of the ureter was the most common complication (55%), followed by urinary leak (41%). But in 50% of cases these can be managed nonoperatively, and they do not affect graft and patient survival ( 17 ). In our series we did not perceive any difference, possibly due to a small number of cases.…”

Section: Discussionmentioning

confidence: 99%

Donor Size Doesn’t Impact En Bloc Kidney Transplant Outcomes: A Single-Center Experience and Review of Literature

Spaggiari¹,

Petrochenkov²,

Patel³

et al. 2022

Transpl Int

View full text Add to dashboard Cite

Few transplant programs use kidneys from donors with body weight (BW)<10 kg due to higher incidence of vascular and urological complications, and DGF. The purpose of this study was to investigate the non-inferiority of pediatric en bloc kidneys from donors with BW<10 kg. We performed a single-center retrospective analysis of en bloc kidney transplants from pediatric donor cohort (n = 46) from 2003 to 2021 and stratified the outcomes by donor BW (small group, donor BW<10 kg, n = 30; standard group, donor BW<10 kg, n = 16). Graft function, rate of early post-transplant complications, graft and patient survival were analyzed. Complication rates were similar between both groups with 1 case of arterial thrombosis in the smaller group. Overall graft and patient survival rates were similar between the small and the standard group (graft survival—90% vs. 100%, p = 0.09; patient survival—96.7 vs. 100%, p = 0.48). Serum creatinine at 1, 3, 5 years was no different between groups. Reoperation rate was higher in the small group (23.3% vs. 6.25%, p = 0.03). The allograft from small donors could be related to higher reoperation rate in the early post-transplant period, but not associated with lower long-term graft and patient survival.

show abstract

“…In an attempt to reduce waiting time on dialysis for pediatric patients, we started to utilize kidneys from pediatric donors as en bloc kidney transplants back in 2014. These kidneys were not utilized in children based on the assumed increased risk of vascular thrombosis, urological complications, small nephron mass, hyperfiltration injury, and DGF 4–8 . Vascular thrombosis has historically been a prevalent complication following en bloc kidney transplantation, with reported incidences ranging from 12.5% to 25%, particularly among infants weighing less than 5 kg 9–11 …”

Section: Discussionmentioning

confidence: 99%

Pediatric en bloc kidney transplant from donors <15 kg: An excellent approach to expand the pediatric deceased donor pool

Azzam,

Tawfeeq,

Obeid

et al. 2024

Pediatric Transplantation

View full text Add to dashboard Cite

IntroductionMost kidneys from small pediatric donors are transplanted to adult recipients because of the perceived risk of surgical complications and graft thrombosis. In this study, we aim to demonstrate our favorable outcomes in transplanting pediatric kidneys from donors <15 k into pediatric recipients.MethodsThis study retrospectively analyzes the outcomes of seven pediatric recipients of en block kidney transplants from pediatric donors weighing <15 kg performed at King Fahad Specialist Hospital‐Dammam from December 2014 to January 2018.Baseline characteristics of donors and recipients were collected. The incidences of surgical complication, immediate, and intermediate graft function were the primary outcomes.ResultsThe study included seven recipients monitored for a mean duration of 6.86 ± 1.35. Donors’ and recipients’ mean weights were 7.4 ± 3.2 kg and 20.7 ± 9.2 kg, respectively. Ureteric stricture occurred in one patient. There was a substantial improvement of 1‐year estimated glomerular filtration rate (eGFR) compared to the 1‐week mark (106.7 ± 26.38 mL/min. 1.73 m2 vs. 63.7 ± 22.92 mL/min/1.73 m2, p = .0069). The observed improvement in renal function persisted at the 5‐year mark and during the last follow‐up, with eGFR of 70.3 ± 40.7 mL/min/1.73 m2, and 79.8 ± 30.8 mL/min/1.73 m2, respectively. There was also increase of 27.9% in the size of the en bloc kidney observed at the 6 months.ConclusionIn a specialized transplant center with highly skilled surgeons, the utilization of en bloc kidney transplant from donors weighing less than 15 kg is an effective strategy for expanding the donor pool and ensuring favorable graft outcomes.

show abstract

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

Cited by 9 publications

References 31 publications

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

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

Donor Size Doesn’t Impact En Bloc Kidney Transplant Outcomes: A Single-Center Experience and Review of Literature

Pediatric en bloc kidney transplant from donors <15 kg: An excellent approach to expand the pediatric deceased donor pool

Contact Info

Product

Resources

About