Transplantation of infant en bloc kidneys into paediatric recipients

Area of Science:

• Pediatric Nephrology
• Transplantation Surgery
• Pediatric Urology

Background:

• End-stage renal failure (ESRF) in children necessitates renal replacement therapy.
• En bloc renal transplantation (EBT) from infant donors is a viable option for pediatric ESRF.
• Potential complications may limit EBT's widespread adoption in pediatric nephrology centers.

Purpose of the Study:

• To evaluate the perioperative and long-term outcomes of en bloc renal transplantation in pediatric recipients.
• To assess graft function, growth, and potential complications associated with infant donor EBT.

Main Methods:

• Retrospective analysis of five pediatric patients undergoing en bloc renal transplantation from infant donors.
• Evaluation of perioperative complications, including graft vascular events and urinary tract obstructions.
• Long-term follow-up assessing graft function (absolute and relative GFR), kidney growth (MRI), and patient survival.

Main Results:

• Two cases of atypical hemolytic uremic syndrome, two of interstitial nephropathy, and one of branchio-oto-renal syndrome were included.
• Perioperative complications included one instance of renal artery thrombosis (managed with reconstruction) and one vesicoureteric obstruction (managed with JJ-catheter).
• All grafts demonstrated good long-term function, with increasing absolute GFR and kidney size adapting to body mass. Relative GFR remained stable in most patients.

Conclusions:

• En bloc renal transplantation from infant donors is a safe and effective treatment for pediatric end-stage renal failure.
• The procedure facilitates graft growth and functional adaptation to the recipient's body size.
• EBT offers a promising solution for improving long-term outcomes in young children with kidney failure.