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Renal function changes over time in adult recipients of small pediatric kidneys. Evidence against hyperperfusion
al-Bader W el-R1, D Landsberg, A D Manson
1Department of Medicine, St. Paul's Hospital, University of British Columbia, Vancouver, Canada.
Insights
Pediatric donor kidneys can be safely used in adult kidney transplant recipients. This study found no significant difference in renal function or graft loss between pediatric and adult kidney transplants, supporting their use when pediatric recipients are unavailable.
Area of Science:
- Nephrology
- Transplantation Immunology
- Pediatric Nephrology
Background:
- Debate exists on using pediatric donor kidneys in adult end-stage renal disease (ESRD) patients due to concerns about size mismatch and hyperperfusion injury.
- Small kidney size may compromise metabolic demands of adult recipients, potentially increasing graft loss risk.
Purpose of the Study:
- To evaluate the impact of small kidney size on renal outcomes in adult recipients of pediatric donor kidneys.
- To compare renal function and graft survival between adult recipients of pediatric kidneys and adult recipients of adult kidneys.
Main Methods:
- Retrospective review of adult patients receiving renal transplants.
- Comparison of 37 recipients of pediatric kidneys (age < 7 years) with 74 matched recipients of adult kidneys.
- Outcomes assessed included calculated creatinine clearance, proteinuria, graft biopsy findings, and late graft loss due to chronic rejection.
Main Results:
- No significant difference in calculated creatinine clearance was observed between pediatric and adult kidney transplants at 6 months (43.8 vs. 50.7 ml/min) or 3 years (56.3 vs. 56.2 ml/min).
- Pediatric kidney recipients showed no increased evidence of proteinuria or late graft loss compared to adult kidney recipients.
- The study did not demonstrate detrimental effects of small kidney size relative to recipient size on renal outcomes.
Conclusions:
- The use of pediatric donor kidneys in adult recipients is supported by these findings.
- Small kidney size does not appear to negatively impact renal outcomes in adult transplant recipients.
- This practice is viable when pediatric recipients are not available.
Abstract:
There has been considerable debate regarding the use of pediatric donor kidneys in adults with end-stage renal disease. These small kidneys may not be able to deal with the metabolic demands of the large adult size, and thus pediatric kidneys may be at higher risk of loss due to hyperperfusion injury. To study the impact of small kidney size on renal outcome, we studied two groups of patients. This retrospective review of patients at a single institution compared recipients of pediatric renal transplants (age < 7 years, n = 37) to a matched group of adult-kidney recipients (1:2 ratio, n = 74). The groups were matched for age, sex, diabetic status, HLA type, and duration of follow-up. Primary outcomes of interest were: calculated creatinine clearance at 6 months, 1 year, 2 years, and 3 years after transplantation and evidence of hyperperfusion damage as determined by proteinuria, graft biopsy, and late graft loss due to chronic rejection. This study demonstrates no significant difference in calculated creatinine clearance between pediatric and adult transplants at 6 months (43.8 vs. 50.7 ml/min, respectively) or at 3 years after transplantation (56.3 vs. 56.2 ml/min), nor was there any evidence of increased proteinuria or late graft loss in the pediatric-kidney recipients compared with adult-kidney recipients. Our data do not demonstrate the detrimental effects of small kidney size relative to recipient on subsequent renal outcomes, and thus support the practice of pediatric donor kidneys being used in adult recipients when pediatric recipients are not available.