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Orthotopic Kidney Auto-Transplantation in a Porcine Model Using 24 Hours Organ Preservation And Continuous Telemetry
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Optimizing recovery, utilization and transplantation outcomes for kidneys from small, ≤20 kg, pediatric donors

D G Maluf1, R J Carrico, J D Rosendale

  • 1Transplant Division, Department of Surgery, University of Virginia, Charlottesville, VA.

American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons
|September 10, 2013
PubMed

Insights

Transplanting kidneys from small pediatric donors involves trade-offs. While en bloc kidney transplants offer better survival, single kidney transplants yield excellent outcomes at experienced centers.

Area of Science:

  • Nephrology
  • Transplantation Surgery
  • Pediatric Surgery

Background:

  • Optimizing kidney transplantation from small pediatric donors (≤20 kg) presents challenges regarding donor number versus transplant outcome.
  • The choice between single versus en bloc kidney transplantation strategies involves technical risks and impacts utilization.

Purpose of the Study:

  • To analyze kidney recovery, utilization, and 1-year transplant outcomes from small pediatric donors (≤20 kg).
  • To compare outcomes of single versus en bloc kidney transplantation in recipients of pediatric donor kidneys.

Main Methods:

  • Utilized the Organ Procurement and Transplantation Network (OPTN) database for data from January 1, 2005, to June 30, 2010.
  • Examined 2352 kidneys from pediatric donors (≤20 kg) transplanted into 1531 recipients, categorizing into single kidney transplants (SKTs) and en bloc kidney transplants (EBKTs).
  • Analyzed factors associated with graft failure, including donor weight, transplant type, cold ischemia time, donor origin, and transplant center volume.

Main Results:

  • Increased donor weight correlated with higher recovery, transplantation, and SKT rates.
  • Graft failure was associated with lower donor weight, SKT (vs. EBKT), longer cold ischemia time, nonlocal donors, and lower volume centers.
  • Lower donor weight amplified the negative impact of low center volume but not SKT on outcomes.

Conclusions:

  • En bloc kidney transplantation (EBKT) provides superior 1-year graft survival but results in fewer transplants compared to single kidney transplantation (SKT).
  • SKTs achieve excellent outcomes when performed at high-volume, experienced transplant centers.
  • Strategic selection of transplant approach based on donor characteristics and center expertise is crucial for optimizing pediatric kidney transplantation.
Keywords:
Center experiencegraft survivalkidney transplantationpediatric donor

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