Renal transplantation from donors aged < 6 years into children yields equal graft survival when compared to older donors.

Several articles have shown inferior renal allograft survival in patients receiving kidneys from young cadaver donors. We therefore assessed the survival and function of the first cadaveric graft from donors aged under 6 years of age, transplanted after 1983. The results were compared with the outcome of children receiving kidneys from older donors. Graft survival and serum creatinine were analyzed retrospectively at various time intervals after first cadaveric transplantation in 35 pediatric recipients of renal transplants grafted between 1983 and 1996 from donors < 6 years of age. Their data were compared with those of 167 pediatric recipients of renal transplants grafted from older donors. The proportion of young donors remained constant throughout the observation period. Mean recipient age was 10.4 years (range 3.2-17.5 years) in the patients grafted from donors < 6 years of age, not much different from the mean age of the donors in the 6+ years group (12.5 years, range 2.3-18.6 years). Five-year patient survival did not differ between the two groups (89 vs. 90%). In 1983-1996, graft survival rate of kidneys from donors aged < 6 years after one year was 77% (donors aged 6+ years=76%), after 2 years 66% (donors aged 6+ years=68%), after 3 years 62% (donors aged 6+ years=66%), and after 5 years 55% (donors aged 6+ years=60%, n.s., Log-rank test). In 1994-1996, 2-year graft survival was 88% (controls 91%, n.s.). In children receiving a cadaveric graft from a donor aged < 6 years, mean serum creatinine fell from 132+/-101 (SD) micromol/l after 3 months to 101+/-66 micromol/l after 12 months, and was 110+/-52 micromol/l after 5 years. This compared with a serum creatinine of 131+/-108 micromol/l after 3 months, 132+/-97 micromol/l after 12 months and 143+/-81 micromol/l after 5 years in children receiving grafts from older donors. When transplanting renal allografts from young donors into children, there was no significant difference in graft survival between donors aged < 6 years and older donors or in graft function. We conclude that good results from young donors can be obtained in a specialized center, and therefore the restriction of kidney selection to donors aged > 6 years may not be justified.