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Single pediatric donor kidneys for adult recipients: the San Antonio experience
F H Wright1, L H Banowsky, M Floyd
1Department of Renal and Pancreas Transplantation, San Antonio Regional Hospital, Texas, USA.
Insights
Pediatric kidneys from donors aged 4 years or younger show significant growth and adequate function in adult recipients. Despite vulnerability to rejection, their survival rates are comparable to older deceased donors, highlighting their potential as an underutilized resource.
Area of Science:
- Nephrology
- Transplantation Immunology
- Pediatric Urology
Background:
- The use of pediatric donor kidneys in adult recipients is a subject of ongoing research.
- Understanding the long-term outcomes of single pediatric kidney transplants is crucial for optimizing donor utilization.
- Cyclosporine A (CsA) therapy is a standard immunosuppressive regimen in transplantation.
Purpose of the Study:
- To evaluate the growth, function, and survival of single kidneys from young pediatric donors (< or = 4 years) transplanted into adult recipients.
- To compare the outcomes of these transplants with those from older donors and en-bloc pediatric transplants.
- To assess the impact of induction therapy and rejection treatment on graft survival.
Main Methods:
- Retrospective analysis of single kidney transplants from donors aged 4 years or younger into adult recipients.
- Evaluation of early and late renal function, allograft growth, and survival rates.
- Comparison with historical data from older deceased donors and en-bloc pediatric donor transplants.
- Assessment of graft survival in recipients receiving specific induction therapy protocols.
Main Results:
- Single kidneys from donors < or = 4 years exhibit early, sustained growth and adequate renal function in adult recipients.
- Graft survival rates are comparable to those of kidneys from deceased donors > 50 years of age.
- One-year graft survival of 75% was observed in recipients receiving 14 days of induction therapy and aggressive rejection treatment.
- Allograft loss due to surgical complications was 5%, and early rejection was a significant concern.
Conclusions:
- Kidneys from donors aged 4 years or younger are a viable and underutilized resource for adult kidney transplantation.
- Careful patient selection and optimized immunosuppression protocols can mitigate the risks of rejection and improve outcomes.
- These pediatric grafts demonstrate promising growth and function, supporting their use in adult recipients.
Abstract:
Early, sustained and significant growth occurs in single kidneys from donors < or = 4 years of age transplanted into adult recipients who are receiving CsA therapy. Early and late renal function of single kidneys from donors < or = 4 years of age transplanted into adult recipients is more than adequate. Allograft loss from surgical complications (5%) is not excessive. Allografts from donors < or = 4 years of age are very vulnerable to early rejection. Allograft survival of single kidneys from donors < or = 4 years of age is equal to that reported for cadaveric kidneys from donors > 50 years of age. Single kidneys from donors < or = 5 years of age have an allograft survival equal to that for kidneys from donors of the same age that are transplanted en-bloc. One-year allograft survival among recipients of kidneys from donors < or = 4 years of age receiving 14 days of induction therapy and aggressive treatment of rejection (75%) approaches that of the ideal donor (83%). Kidneys from donors < or = 4 years of age represent an underutilized resource.