Kidney transplantation from pediatric donors: size-match-based allocation

Area of Science:

• Nephrology
• Transplantation Surgery
• Pediatric Surgery

Background:

• Pediatric donor kidneys historically linked to poorer transplant outcomes.
• Single kidney grafts from pediatric donors are increasingly utilized.
• Limited data exists on long-term outcomes of single pediatric kidney grafts in mixed pediatric and adult recipients.

Purpose of the Study:

• To evaluate the long-term efficacy and safety of single pediatric kidney grafts in both pediatric and adult recipients.
• To analyze graft and patient survival rates over a 20-year period.
• To identify factors influencing graft success in pediatric kidney transplantation.

Main Methods:

• Retrospective chart review of 29 recipients transplanted between 1986 and 2005.
• Inclusion criteria: single kidney graft from a donor aged 6 years or younger.
• Data collected: donor/recipient demographics, creatinine levels, graft/patient survival, causes of graft loss. Glomerular filtration rate (GFR) calculated using the Schwartz formula.

Main Results:

• All 29 recipients remain alive at a mean follow-up of 92 months.
• Five grafts were lost: 1 primary non-function, 1 recurrent FSGS, 3 chronic rejection.
• Grafts from donors <= 3 years old were associated with all graft losses. Actuarial graft survival was 93.2% at 1 year, 89.6% at 5 years, and 81.9% at 10 years. Mean GFR at 1 and 5 years post-transplant were 84.2 and 98.3 mL/m(2)/1.73, respectively.

Conclusions:

• Single kidney grafts from pediatric donors can achieve favorable long-term outcomes in both pediatric and adult recipients.
• Kidneys from very small pediatric donors (< or = 3 years) require careful consideration for allocation, preferably to recipients of similar weight.
• Transplantation of single pediatric kidneys into older children and adults is a viable option when appropriately matched.