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Effect of donor source on renal allograft function in children on triple immunosuppression
J Laine1, F Fyhrquist, C Holmberg
1II Department of Pediatrics, University of Helsinki, Finland.
Insights
Kidney transplant outcomes from deceased (CAD) and living related donors (LRD) were compared. CAD grafts showed lower initial function but stabilized, with minimal long-term differences, suggesting donor source has little impact on dysfunction.
Area of Science:
- Nephrology
- Transplantation Immunology
- Pediatric Nephrology
Background:
- Renal transplantation outcomes typically differ between cadaver (CAD) and living related donors (LRD).
- Previous studies reported excellent 1-year graft survival for both CAD and LRD using triple immunosuppression.
Purpose of the Study:
- To compare glomerular and tubular function in pediatric renal grafts from LRD versus CAD donors over 3 years post-transplantation.
- To assess the long-term impact of donor source on allograft function and dysfunction.
Main Methods:
- Prospective study comparing 23 LRD and 22 CAD renal grafts in preschool children.
- Glomerular filtration rate (GFR), renal plasma flow, and tubular function were assessed over 3 years.
- Serum urate levels and cyclosporine-induced nephrotoxicity markers were monitored.
Main Results:
- CAD grafts exhibited lower initial GFR and renal plasma flow compared to LRD grafts.
- Both LRD and CAD graft functions remained stable throughout the 3-year follow-up period.
- No significant differences in GFR or tubular function were observed after 6 months; however, LRD grafts showed better urate handling at 36 months.
Conclusions:
- Donor source had minimal impact on the development of progressive allograft dysfunction in pediatric renal transplantation with triple immunosuppression.
- Cyclosporine-induced nephrotoxicity, including hyperkalemia, was noted.
- Adult CAD grafts are a viable option for pediatric renal transplantation when using triple immunosuppression.
Abstract:
Results of renal transplantation using cadaver donors (CAD) are usually inferior to those using living related donors (LRD). We have previously reported 100% 1-year CAD and LRD graft survival using adult cadaver donors and triple immunosuppression. In the present study glomerular and tubular function of 23 LRD and 22 CAD grafts (median ages 3.5 and 2.6 years) were compared during 3 years after transplantation. Glomerular filtration rate (GFR) and renal plasma flow were lower in CAD grafts but remained stable in both groups. The mean GFRs were 87.3 and 63.2 ml/min/1.73 m2 at discharge and 82.8 and 72.5 ml/min/1.73 m2 at 36 months in LRD and CAD grafts respectively. No significant differences were found after 6 months. Tubular function was good in both groups. The only significant difference was in urate handling at 36 months (mean serum urate 396 mumol/l in CAD, 301 in LRD grafts, P < 0.05). Cyclosporin nephrotoxicity manifested as hyperkalaemia due to reduced distal potassium secretion and/or adrenal suppression. In conclusion, donor source had little effect on the development of progressive allograft dysfunction using adult CAD grafts and triple immunosuppression with CsA administered in three daily doses to preschool children.