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Kidneys from pediatric donors: risk versus benefit
H H Neumayer1, S Huls, M Schreiber
1Department of Internal Medicine-Nephrology, Friedrich-Alexander University, Erlangen-Nürnberg, Germany.
Clinical Nephrology
|February 1, 1994
Summary
Kidney transplants from young children (under 10 years) into adults are linked to worse graft survival and complications like hypertension and glomerulosclerosis. This suggests a more cautious approach is needed for these pediatric donor kidneys.
Area of Science:
- Nephrology
- Transplantation Immunology
- Pediatric Nephrology
Background:
- Adult renal transplant recipients sometimes receive grafts from pediatric donors.
- The long-term outcomes of these transplants are not fully understood.
- Early observations suggest potential complications in recipients of very young donor kidneys.
Purpose of the Study:
- To evaluate the outcomes of adult renal transplant recipients who received grafts from donors aged 10 years or younger.
- To compare graft survival and complication rates between young and older pediatric donor kidneys.
- To identify risk factors associated with pediatric donor kidney transplantation in adults.
Main Methods:
- Retrospective analysis of 74 adult patients receiving renal grafts from donors <= 10 years of age.
- Comparison with 804 adult patients receiving grafts from donors > 10 years of age.
- Kaplan-Meier survival analysis and subanalysis based on donor age strata (<=5 years vs. 6-10 years).
Main Results:
- Graft survival was significantly worse in recipients of kidneys from donors <= 10 years compared to older donors.
- Younger donor age (< 10 years) was associated with increased risks of renal artery thrombosis and glomerulonephritis.
- Severe hypertension, proteinuria, and progressive renal failure were observed in recipients of very young donor kidneys (< 36 months).
Conclusions:
- Transplantation of kidneys from donors <= 10 years into adult recipients is associated with poorer graft survival and specific complications.
- Glomerular hyperperfusion and subsequent glomerulosclerosis/crescent formation appear to be key mechanisms of injury.
- A more conservative approach is recommended for using pediatric donor kidneys (<= 10 years) in adult renal transplant recipients.