The use of single pediatric cadaver kidneys for transplantation

We have reviewed our experience with 126 single pediatric cadaver kidneys (donor ages 9 months to 16 years) transplanted over a 10-year period. There were 17 donors aged 0-2 years, 55 donors aged 0-6 years, 34 donors aged 7-12 years, and 37 donors aged 13-16 years. One-year patient and graft survival was 88.2%/76.5%, 91%/74%,88.3%/69.1%, and 94.4%/80.6% for the respective groups. One-year patient and graft survival for an adult donor control group was 93%/69%. The percentage of recipients requiring dialysis in the early posttransplant period was 70.6%, 54.5%, 52.9%, 51.4%, and 52.4% for all groups, respectively. The time to reach a nadir creatinine was similar in all groups (24-30 days). While the functional outcome was comparable to cadaver transplantation utilizing adult donor kidneys, a higher incidence of infections and technical complications were encountered in the young-donor-age groups. Overall, there were 12 ureteral complications (8 fistulas, 4 stenoses), 3 bladder fistulas, and 4 renal artery stenoses. The urologic complication rate in kidneys from donors 0-2 years of age was 23.5% (all ureteral fistulas) versus 5% in the kidneys from adult donors. Only one graft was lost due to a technical complication. We conclude that, while cadaver kidneys from donors in the young age groups may be utilized successfully for transplantation, a higher incidence of urologic complications may be associated with their use. Careful harvesting and intraoperative techniques may minimize complications when utilizing kidneys from these donors.