Related Experiment Video
Updated: May 6, 2026
Robot-Assisted Kidney Transplantation
Published on: July 19, 2021
En bloc kidneys transplanted from infant donors less than 5 kg into pediatric recipients
Wen-Yu Zhao1, Lei Zhang, You-Hua Zhu
11 Organ Transplantation Institute of PLA, Changzheng Hospital, Second Military Medical University, Shanghai, China. 2 Department of Nephrology and Rheumatology, Children's Hospital of Fudan University, Shanghai, China. 3 Address correspondence to: Li Zeng, Prof, M.D., Organ Transplantation Institute of PLA, Changzheng Hospital, Second Military Medical University, No. 415 Fengyang Road, Huangpu District, Shanghai 200003, China.
Insights
En bloc kidney transplants from deceased infant donors show promising results in pediatric recipients, with high patient survival rates. This approach expands the donor pool for children needing kidney transplants.
Area of Science:
- Nephrology
- Pediatric Surgery
- Transplantation Immunology
Background:
- Donor kidney shortage necessitates exploring alternative sources like deceased infant donors.
- En bloc kidney transplantation is a viable strategy to increase graft availability for pediatric recipients.
Observation:
- Four pediatric recipients underwent en bloc kidney transplantation using deceased infant donors (33-56 days old).
- Surgical implantation involved extraperitoneal placement with specific vascular and ureteral anastomoses.
- Post-transplant immunosuppression included basiliximab, tacrolimus, and mycophenolic acid, with prophylactic anticoagulation.
Findings:
- After 2-14 months follow-up, patient survival was 100% and graft survival was 75%.
- Complications included delayed graft function, urine leak, hemorrhage, and one early graft loss due to thrombosis.
- Three recipients demonstrated excellent graft function with a median serum creatinine of 1.1 mg/dL.
Implications:
- En bloc transplantation from infant donors offers a promising solution to the pediatric kidney donor shortage.
- Encouraging the use of infant donors can improve outcomes for children awaiting kidney transplants.
- Further research into optimizing surgical techniques and immunosuppression protocols is warranted.
Background:
Given the shortage of donor kidneys, the use of grafts from deceased infant donors is a potential approach to expand the donor pool. Four infant en bloc kidney transplants in pediatric recipients were reported, performed between 2012 and 2013 in the center.
Methods:
The en bloc graft was implanted extraperitoneally in the right iliac fossa. The distal end of the donor aorta was anastomosed end-to-end to the internal iliac artery, while the donor vena cava was anastomosed (end-to-side) to the external iliac vein. Both ureters were anastomosed individually to the bladder, with the exception of one case in which a donor bladder patch was anastomosed to the bladder. After the operation, the recipients received basiliximab as induction therapy followed by tacrolimus and mycophenolic acid for immunosuppression. Prophylactic anticoagulation was used postoperatively.
Results:
Recipients included two girls and two boys with age ranging from 4.6 to 11.6 years. Donor age ranged from 33 to 56 days with weight ranging from 2.5 to 5.0 kg. After a follow-up of 2 to 14 months, patient and graft survivals were 100% and 75%, respectively. Complications included delayed graft function in one patient, urine leak in one, and anticoagulation-related hemorrhage in one. One graft was lost early from vascular thrombosis. The remaining three recipients had excellent graft function with median serum creatinine of 1.1 mg/dL (range, 0.8-1.3 mg/dL) at last follow-up.
Conclusions:
Promising outcomes can be obtained from en bloc transplantation from infant donors. The use of this donor population for pediatric recipients should be encouraged.
Related Concept Videos
01:28Kidney Transplant I: Introduction
01:26Kidney Transplant II: Surgical Procedure