Utilisation of small paediatric donor kidneys for transplantation

Abstract

With the increasing need for kidney transplantation in the paediatric population and changing donor demographics, children without a living donor option will potentially be offered an adult deceased donor transplant of marginal quality. Given the importance of long-term graft survival for paediatric recipients, consideration is now being given to kidneys from small paediatric donors (SPDs). There exist a lack of consensus and a reluctance amongst some centres in transplanting SPDs due to high surgical complication rates, graft loss and concerns regarding low nephron mass and long-term function. The aim of this review is to examine and present the evidence base regarding the transplantation of these organs. The literature in both the paediatric and adult renal transplant fields, as well as recent relevant conference proceedings, is reviewed. We discuss the surgical techniques, long-term graft function and rates of complications following transplantation of SPDs. We compare graft survival of SPDs to adult deceased donors and consider the use of small paediatric donors after circulatory death (DCD) organs. In conclusion, evidence is presented that may refute historically held paradigms regarding the transplantation of SPDs in paediatric recipients, thereby potentially allowing significant expansion of the donor pool.

Kidney transplantation with allografts from infant donors—Small organs, big value

“…3,[21][22][23][24][25][26][27][28] Our data support the usage of such allografts, as these are at least non-inferior to the standard criteria donor group as observed by other groups. 6,29,30 Our policy is to prioritize children for kidney allografts from ju- These results are encouraging, and further validation in a greater number of patients, as well as at additional centers, 31 is needed.…”

“…As such, infant donors are not routinely considered by all transplant centers. [3][4][5] Although a recent analysis advocated the feasibility of using these organs based on a selective and careful approach, 6 it is still unclear whether an age threshold exists with respect to the maturity of these organs. GFR in neonates are considerably lower than in adults.…”

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

“…It is interesting to note, however, that cold ischemia time has not been identified as a risk factor for urologic complications in any of the previously published studies in recipients of adult and pediatric deceased donor kidneys. [10][11][12]17,19,21 Also, formal study of the potential impact of (shorter) cold ischemia time impact would presently not be possible. Such a study would require performance of many more EBKs using local donors in order to generate cases with short preservation times, but only a few transplant centers are performing EBKs from very small pediatric donors.…”

“…A UK registry analysis of graft loss causes after 56 EBKs reported no losses from urologic complications, but it remains unclear whether this graft loss cause was even considered as a separate category 20. Another recent single-center analysis of surgical complications after 100 EBKs from donors >8 kg performed over a 22-year period neither specifically defined nor reported any urologic complications 21. In our large EBK single-center cohort, we observed a 9.8% overall urologic complication rate (vs in 4.2% of our center's adult deceased donor graft recipients transplanted during the same time period [data not shown]).…”

Intravesical monitoring of intra‐abdominal pressure after renal transplantation in children: A safety and feasibility study

“…In total, 29 IAP measurements were performed in RTX patients and 121 in controls. The mean post-operative IAP was 7.4 ± 4.3 [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] mm Hg following RTX and 8.1 ± 3.7 [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] mm Hg in controls.…”