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Updated: Jun 4, 2026
Robot-Assisted Kidney Transplantation
Published on: July 19, 2021
[Kidney transplant from living donors in children?]
Fabrizio Ginevri1, Luca Dello Strologo, Isabella Guzzo
1Medicina Clinica e Sperimentale dei Trapianti, U.O.C. Nefrologia, Istituto G. Gaslini, Genova, Italy. fabrizioginevri@ospedale-gaslini.ge.it
Insights
Living-donor kidney transplants improve outcomes for children with end-stage renal disease. Careful donor selection and adherence to guidelines are crucial for minimizing risks and ensuring graft survival.
Area of Science:
- Nephrology
- Transplant Surgery
- Pediatric Medicine
Context:
- Pediatric end-stage renal disease necessitates renal replacement therapy.
- Living-donor kidney transplantation offers superior outcomes compared to deceased-donor options.
- Careful evaluation of donor and recipient is essential for successful transplantation.
Purpose:
- To outline the benefits and risks of living-donor kidney transplantation in pediatric patients.
- To identify contraindications for living donation, including specific renal diseases and donor-recipient factors.
- To emphasize the importance of standardized protocols and donor safety in pediatric living-donor kidney transplantation.
Summary:
- Living-donor kidney transplantation provides better functional recovery and quality of life for children with end-stage renal disease.
- Contraindications for living donation include diseases like focal segmental glomerulosclerosis and atypical HUS due to high recurrence and graft loss rates.
- Donor selection criteria, such as age and weight relative to the recipient, and potential perioperative and long-term complications must be considered.
Impact:
- Facilitates informed decision-making for pediatric kidney transplant candidates and their families.
- Promotes safer living-donor kidney transplantation practices through adherence to established guidelines.
- Contributes to improved long-term graft survival and patient quality of life in pediatric nephrology.
- Highlights the critical role of donor safety and risk assessment in pediatric living donation programs.
Abstract:
A living-donor kidney transplant offers a child at the terminal stages of renal disease better functional recovery and quality of life than an organ from a deceased donor. Before starting the procedure for a living-donor transplant, however, it is necessary to establish if it is really safe. There are diseases, such as focal segmental glomerulosclerosis, atypical HUS and membranoproliferative glomerulonephritis with dense deposits, for which living donation is not recommended given the high incidence of recurrence of the disease but also the frequent loss of the graft. Regarding the selection of the donor, an increased risk of acute rejection has been reported for donors older than 60-65 years and a worsening of the renal outcome if the donor's weight is equal to or less than the recipient's. Finally, it is necessary to take into consideration that complications may arise in the donor both in the perioperative period and in the long term. In conclusion, kidney transplant from a living donor is a natural choice within the pediatric setting. The parents, usually young and highly motivated to donate, are the ideal donors. However, although the risks associated with donation are minimal, they are not totally absent, and consequently it is mandatory to follow standardized procedures according to the guidelines issued by the Centro Nazionale Trapianti.
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