Limitations of pediatric donor kidneys for transplantation

The shortage of grafts for kidney transplantation (Tx) has resulted in an expansion of criteria for pediatric donors. However, the limitations of pediatric donors for kidney Tx are not yet clearly established. We investigated the outcomes of recipients with pediatric kidney grafts from Colorado to elucidate the state of pediatric kidney grafts distributed in the nation and to clarify the limitations of pediatric donor kidneys for Tx.

Between January 1989 and July 1997, 675 organ donors in Colorado were utilized for Tx. Fifty-seven of these (8.4%) were 10 yr old or younger. Thirty-two of the 57 pediatric donors provided kidneys for 50 recipients both inside and outside Colorado. Forty-four of the 50 recipients were followed and are available for this study.

Graft survival rates were 85.6, 77.3, 71.3 and 65.4% for 1, 2, 3 to 5, and 6 yr of follow-up, respectively. Thirteen recipients lost the grafts, including three graft losses within 2 wk, due to primary nonfunction, venous and arterial thrombosis. The mean serum creatinine value in 31 recipients with functioning grafts was 1.3 +/- 0.4 mg/dL at the time with follow-up of 45.9 +/- 28.3 months (5-96 months). Six grafts from 13-month to 3-yr-old donors were transplanted en-bloc and 5 of these have survived. Four of the 5 single grafts from 3 to 5-yr-old donors have functioned. Of the 33 grafts from donors aged 6-10 yr, including 30 single and 3 en-bloc grafts, 22 were still functioning. With respect to donor weight, 4 of the 5 en-bloc grafts from donors weighting 9-15 kg, and 6 of the 7 single and the 1 en-bloc grafts from donors weighing 15-20 kg were still functioning. Cold ischemic time (CIT) within 37.5 h was not associated with early graft outcome.

The kidneys from donors 1-3 yr old and/or weighing 9-15 kg could be successfully transplanted en-bloc and those from donors more than 3 yr old and/or weighing 15 kg were best transplanted by single grafts.