Renal transplant donation from a deceased cardiac graft recipient: a case for marginal donors

We describe a case of dual kidney transplant in a highly sensitized 18-yr-old male patient followed for chronic renal failure secondary to focal and segmental glomerulosclerosis. The donor was a six-yr-old boy who had received a cardiac transplant at the age of three months and had been treated with CNIs for over five yr. Renal biopsy performed before the transplant revealed focal sclerosis in 30-40% of the donor's glomeruli. Considering the long expected time on the waiting list for this highly sensitized boy and the absence of prohibited antigens in the donor, we decided to perform the transplant. To increase renal mass, both kidneys were transplanted. Clinical course was good but the patient developed proteinuria, which improved with ramipril. We performed two renal biopsies in the first nine months post-transplant which showed a progressive increase of the glomerulosclerosis. Despite the histology, renal function remains good 24 months after transplant. This is the first report of a transplant using a kidney from a donor who had received long-term CNI treatment. Short-term outcome is satisfactory. We suggest that marginal donors could also be considered for donation in pediatric age for selected groups of patients.