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Updated: Jun 24, 2025
Robot-Assisted Kidney Transplantation
Published on: July 19, 2021
Kidney Transplantation in ≤15 kg Children: Outcomes and Prognostic Indicators-A Review of the Organ Procurement and
Raffi Melikian1, Yong Kwon1,2, Nathan Kohrman1
1Department of Abdominal Organ Transplantation, Keck Medical Center, University of Southern California, Los Angeles, California, USA.
Insights
Pediatric kidney transplantation is highly successful for children weighing ≤15kg. Early transplantation, particularly between 1-2 years of age, improves graft survival, while dialysis initiation negatively impacts outcomes.
Area of Science:
- Pediatric Nephrology
- Transplant Surgery
- Immunology
Background:
- Over 2500 children in the US await kidney transplants, with a small subset (≤15kg) facing delayed procedures and uncertain prognoses.
- Current transplant practices for low-weight pediatric recipients are often hindered by center-specific growth parameters, leading to dialysis initiation before transplantation.
- Understanding factors influencing graft and patient survival in this specific pediatric cohort is crucial for optimizing transplant outcomes.
Purpose of the Study:
- To analyze the Organ Procurement and Transplantation Network (OPTN) data from 2001-2021 to identify variables affecting graft and patient survival in pediatric kidney transplant recipients weighing ≤15kg.
- To provide a clearer understanding of prognostication for this challenging pediatric population.
- To inform clinical decision-making regarding the timing and management of kidney transplantation in very low-weight children.
Main Methods:
- Analysis of the OPTN kidney transplant dataset (2001-2021) for pediatric recipients (<18 years, ≤15kg) undergoing primary kidney transplantation (living or deceased donor).
- Kaplan-Meier method used to calculate patient and graft survival probabilities.
- Cox proportional hazards model employed to determine hazard ratios and identify significant predictors of survival.
Main Results:
- The study included 2168 pediatric kidney transplant recipients. Patient survival rates were 98% at 1 year and 97% at 3 years; graft survival rates were 95% at 1 year and 92% at 3 years.
- Pre-transplant dialysis was the only significant factor negatively impacting both patient and graft survival.
- Graft survival was influenced by transplant era, recipient demographics (gender, ethnicity), and donor type. Infants transplanted at age 1 and those with nephrotic syndrome showed better graft survival.
Conclusions:
- Pediatric kidney transplantation demonstrates high success rates, even in the challenging ≤15kg cohort.
- A 'Goldilocks zone' for transplantation, likely between 1-2 years of age, appears optimal, balancing preemptive transplantation, medical optimization, and surgical considerations.
- Optimizing transplant timing and avoiding pre-transplant dialysis are critical for improving long-term outcomes in pediatric kidney recipients.
Background:
Approximately 2500 pediatric patients are awaiting kidney transplantation in the United States, with <5% comprising those ≤15 kg. Transplant in this cohort is often delayed by center-based growth parameters, often necessitating transplantation after the initiation of dialysis. Furthermore, prognostication remains somewhat ambiguous. In this report, we scrutinize the Organ Procurement and Transplantation Network (OPTN) data from 2001 to 2021 to help better understand specific variables impacting graft and patient outcomes in these children.
Methods:
The OPTN kidney transplant dataset from 2001 to 2021 was analyzed. Inclusion criteria included age <18 years, weight ≤15 kg, and recipient of primary living donor kidney transplantation (LDKT) or deceased donor kidney transplantation (DDKT). Patient and graft survival probabilities were calculated using the Kaplan-Meier method. The Cox proportional hazards model was used to calculate hazard ratio (HR) and identify variables significantly associated with patient and graft survival.
Results:
Two thousand one hundred sixty-eight pediatric transplant recipients met inclusion criteria. Patient survival at 1 and 3 years was 98% and 97%, respectively. Graft survival at 1 and 3 years was 95% and 92%, respectively. Dialysis was the sole significant variable impacting both patient and graft survival. Graft survival was further impacted by transplant era, recipient gender and ethnicity, and donor type. Infants transplanted at Age 1 had better graft survival compared with older children, and nephrotic syndrome was likewise associated with a better prognosis.
Conclusion:
Pediatric kidney transplantation is highly successful. The balance between preemptive transplantation, medical optimization, and satisfactory technical parameters seems to suggest a "Goldilocks zone" for many children, favoring transplantation between 1 and 2 years of age.
