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Growth and function of en bloc infant kidney transplants: a preliminary study
D D Nghiem1, S Hsia, J D Schlosser
1Department of Surgery, Allegheny Singer Research Institute, Allegheny General Hospital, Pittsburgh, Pennsylvania 15212.
Insights
En bloc infant kidney transplants demonstrate significant growth and excellent function in adult recipients. These pediatric kidneys adapt well, offering a viable solution for kidney replacement therapy.
Area of Science:
- Nephrology
- Transplantation Surgery
- Pediatric Urology
Background:
- Infant kidneys are a potential source for transplantation.
- En bloc transplantation of infant kidneys is a technique used when single kidneys are too small.
- Assessing the long-term growth and function of these transplants in adult recipients is crucial.
Purpose of the Study:
- To evaluate the growth and functional capacity of en bloc infant kidneys transplanted into adult recipients.
- To determine the viability and efficacy of using infant kidneys for adult renal replacement therapy.
Main Methods:
- Retrospective analysis of 21 en bloc infant kidney transplants in adult recipients.
- Monitoring of serum creatinine, glomerular filtration rate (GFR) using 99mtechnetium-diethylenetriaminepentaacetic acid, kidney volume, and resistive index.
- Statistical comparison of parameters at 1-3, 3-6, and beyond 6 months post-transplant using repeated measures analysis of variance.
Main Results:
- Statistically significant growth of en bloc infant kidneys observed, nearly doubling in volume within 3-6 months and tripling by 6 months.
- Significant increase in GFR, with a nearly 4-fold increase at 3-6 months and a 5-fold increase beyond 6 months.
- Resistive indexes remained within normal limits (0.60-0.63), indicating good vascular perfusion, and recipient blood pressure was normal.
Conclusions:
- En bloc infant kidney transplantation leads to rapid kidney growth in adult recipients.
- These transplants provide excellent and sustained renal function, comparable to adult kidneys.
- Infant en bloc kidneys represent a successful and effective option for adult kidney transplantation.
Abstract:
We evaluated the growth and function of 21 pairs of en bloc infant kidneys transplanted into adult recipients. Serum creatinine, 99mtechnetium-diethylenetriaminepentaacetic acid glomerular filtration rates, kidney volumes and resistive indexes were determined at 1 to 3, 3 to 6 and beyond 6 months, and compared using repeated measures analysis of variance tests. En bloc kidneys grew at a statistically significant rate (p < 0.001), for example nearly 2-fold in 3 to 6 months (209 +/- 69 cc from 132 +/- 70 cc), and approaching 3-fold at 6 months and longer (325 +/- 106 cc). Similarly, the glomerular filtration rates increased almost 4-fold (83 +/- 52 ml. from 23 +/- 11 ml. per minute) and 5-fold (121 +/- 45 ml., p < 0.001), respectively, during the same periods. Resistive indexes remained at normal range (0.60 to 0.63). Recipient blood pressure was normal. Our study shows that infant en bloc kidney transplants grow rapidly and provide excellent function to the adult recipient.