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Donor age and graft function
S Gellert1, S Devaux, B Schönberger
1Department of Pediatric Nephrology, Charité, Humboldt University, Berlin, Germany.
Insights
Pediatric and adult kidney grafts show similar survival and function in children. Graft function adapts to recipient needs, regardless of donor age, ensuring comparable outcomes in pediatric kidney transplantation.
Area of Science:
- Nephrology
- Transplantation Immunology
- Pediatric Nephrology
Background:
- Cadaveric donor kidney grafts are crucial for treating end-stage renal disease in children.
- Donor age is a significant factor influencing graft survival and post-transplant renal function.
- Understanding the long-term outcomes of pediatric versus adult donor grafts is essential for optimizing transplant strategies.
Purpose of the Study:
- To evaluate and compare graft survival and renal function between pediatric and adult donor kidney grafts in pediatric recipients.
- To assess the impact of donor age on glomerular filtration rate (GFR) and effective renal plasma flow (ERPF) post-transplantation.
Main Methods:
- Retrospective analysis of pediatric recipients of cadaveric donor kidney grafts, categorized by donor age (pediatric vs. adult).
- Assessment of graft survival and renal function, including glomerular filtration rate (GFR) and effective renal plasma flow (ERPF), at various time points post-transplantation.
- Measurement of GFR and ERPF using clearances of 51chromium-EDTA and 125iodine-hippurate, respectively.
Main Results:
- No significant difference in graft survival was observed between pediatric and adult donor kidney grafts.
- Glomerular filtration rate (GFR) showed no significant difference between recipients of pediatric or adult donor grafts.
- Effective renal plasma flow (ERPF) was initially higher in adult grafts but normalized by 4-6 months post-transplantation, with pediatric grafts showing adaptive increases in function.
Conclusions:
- Graft survival and renal function are comparable in pediatric recipients of either pediatric or adult donor kidney grafts.
- Kidney graft function demonstrates adaptability to the recipient's requirements, irrespective of donor age.
- These findings support the use of both pediatric and adult donor grafts in pediatric kidney transplantation.
Abstract:
We evaluated survival and renal function of cadaveric donor grafts according to donor age. The median age of the pediatric donors was 7.0 (0.7-16) years in 46 patients [median age 11.8 years (range) 3-16.8 years]. The median age of the adult donors was 34.4 (19-54) years in 59 patients [median age 12.1 years (range) 7-17.3 years]. Thirty patients were treated with azathioprine and prednisolone and 75 with cyclosporine A and prednisolone. The glomerular filtration rate (GFR) and the effective renal plasma flow (ERPF) were determined by the clearances of 51chromium-EDTA and 125iodine-hippurate 1-48 months after kidney transplantation. There was no difference in graft survival between pediatric and adult grafts. There were also no differences in GFR in patients receiving grafts from pediatric or adult donors; 2-3 months after transplantation the GFR in recipients of pediatric grafts was 62 +/- 20 ml/min per 1.73 m2 compared with 61 +/- 21 in those receiving adult grafts. The ERPF in recipients of adult grafts was significantly higher in the 1st month after transplantation: 486 +/- 239 versus 362 +/- 158 ml/min per 1.73 m2. From the 4th to the 6th month after transplantation this difference disappeared: the ERPF of grafts from pediatric donors was 279 +/- 131 ml/min per 1.73 m2 compared with 273 +/- 123 ml/min per 1.73 m2 in grafts from adult donors. Using the single-kidney GFR and ERPF on an age-matched group of probands with minor diseases as references, 2-3 months after transplant the mean GFR of grafts from pediatric donors increased to 118% +/- 51%, whereas the GFR of adult donor grafts fell to 60% +/- 22% over the same period. After 4-6 months the ERPF in pediatric grafts was 96% +/- 55% compared with 50% +/- 22% in adult grafts. We conclude that graft survival and function in children with either a pediatric or an adult graft may not differ because graft function adapts to the requirement of the recipient.