BACKGROUND: Single pediatric kidney transplantation (SKT) in adult recipients has traditionally been considered a high risk because of concerns of technical complications leading to poor graft outcomes. The primary goal of this single-center, retrospective analysis was to compare outcomes after SKT to standard-criteria deceased-donor kidney transplantation (SCDKT). METHODS: We compared outcomes in adult recipients after SKT (n=31; mean donor weight, 27 kg); SCDKT (n=283); pediatric en bloc (n=21), living-donor (n=275), and extended criteria-donor (n=100) kidney transplantations. RESULTS: The death-censored 5-year graft survival after SKT was significantly superior to SCDKT (81.4% vs. 74.5%, P=0.02). The serum creatinine level at 5 years after transplantation was significantly lower in SKT compared with that in SCDKT (1.2 vs. 1.6 mg/dL, P<0.0001). There was a significantly higher incidence of arterial anastomotic stenosis (6.8% vs. 0.4%, P=0.02) and hydronephrosis (12.9% vs. 5.3%, P=0.02) in the SKT cohort compared with SCDKT. Subgroup analysis of the SKT cohort by donor age less than 5 years vs. 6 to 10 years (mean weight, 16.4 vs. 32.7 kg) revealed no differences in patient or graft survival. CONCLUSIONS: Despite a higher incidence of posttransplantation vascular and urological complications, long-term graft survival after SKT (in weight-matched pediatric donors and selected adult recipients) was comparable with that after SCDKT. SKT from very small donors (age, ≤5 years) yielded excellent long-term patient and graft survivals. The use of pediatric donor kidneys should be encouraged to address the problem of organ shortage.
BACKGROUND: Single pediatric kidney transplantation (SKT) in adult recipients has traditionally been considered a high risk because of concerns of technical complications leading to poor graft outcomes. The primary goal of this single-center, retrospective analysis was to compare outcomes after SKT to standard-criteria deceased-donor kidney transplantation (SCDKT). METHODS: We compared outcomes in adult recipients after SKT (n=31; mean donor weight, 27 kg); SCDKT (n=283); pediatric en bloc (n=21), living-donor (n=275), and extended criteria-donor (n=100) kidney transplantations. RESULTS: The death-censored 5-year graft survival after SKT was significantly superior to SCDKT (81.4% vs. 74.5%, P=0.02). The serum creatinine level at 5 years after transplantation was significantly lower in SKT compared with that in SCDKT (1.2 vs. 1.6 mg/dL, P<0.0001). There was a significantly higher incidence of arterial anastomotic stenosis (6.8% vs. 0.4%, P=0.02) and hydronephrosis (12.9% vs. 5.3%, P=0.02) in the SKT cohort compared with SCDKT. Subgroup analysis of the SKT cohort by donor age less than 5 years vs. 6 to 10 years (mean weight, 16.4 vs. 32.7 kg) revealed no differences in patient or graft survival. CONCLUSIONS: Despite a higher incidence of posttransplantation vascular and urological complications, long-term graft survival after SKT (in weight-matched pediatric donors and selected adult recipients) was comparable with that after SCDKT. SKT from very small donors (age, ≤5 years) yielded excellent long-term patient and graft survivals. The use of pediatric donor kidneys should be encouraged to address the problem of organ shortage.
Authors: Yousef Al-Shraideh; Umar Farooq; Hany El-Hennawy; Alan C Farney; Amudha Palanisamy; Jeffrey Rogers; Giuseppe Orlando; Muhammad Khan; Amber Reeves-Daniel; William Doares; Scott Kaczmorski; Michael D Gautreaux; Samy S Iskandar; Gloria Hairston; Elizabeth Brim; Margaret Mangus; Robert J Stratta Journal: World J Transplant Date: 2016-03-24
Authors: Samir Damji; Chris J Callaghan; Ioannis Loukopoulos; Nicos Kessaris; Jelena Stojanovic; Stephen D Marks; Nizam Mamode Journal: Pediatr Nephrol Date: 2018-09-20 Impact factor: 3.714