Expanding the Envelope: Favorable Outcomes Utilizing Kidneys From Small Pediatric Donors (≤ 15 kg)

Area of Science:

• Nephrology
• Transplantation Surgery
• Pediatric Urology

Background:

• Kidney transplantation from small pediatric donors (SPDs, ≤15 kg) is underutilized.
• The practice of splitting SPD kidneys for two recipients is controversial.

Purpose of the Study:

• To evaluate the outcomes of kidney transplants using SPD kidneys.
• To assess graft loss within 30 days post-transplant.
• To compare outcomes based on donor weight categories.

Main Methods:

• Retrospective single-center study of 40 kidney transplants from SPDs.
• Recipients divided into two groups: donor weight <10 kg (Group A, n=24) and ≥10 kg (Group B, n=16).
• Primary endpoint: graft loss within 30 days; secondary endpoints: graft survival, function, and complications.

Main Results:

• 100% patient survival and 95% overall graft survival at a mean follow-up of 402 days.
• Graft survival was 91.7% in Group A and 100% in Group B (P=0.24).
• Similar graft function (creatinine, eGFR) and surgical complication rates between groups; recipient-to-donor weight ratio (RTDWR) predicted complications.

Conclusions:

• Early splitting of SPD kidneys results in favorable graft survival and function.
• Outcomes are independent of donor weight and age.
• Early splitting of SPD kidneys should be considered for broader utilization.