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Schild R, Carvajal Abreu K, Büscher A, Kanzelmeyer N, Lezius S, Krupka K, Weitz M, Prytula A, Printza N, Berta L, Saygili SK, Sellier-Leclerc AL, Spartà G, Marks SD, Kemper MJ, König S, Topaloglu R, Müller D, Klaus G, Weber S, Oh J, Herden U, Carraro A, Dello Strologo L, Ariceta G, Hoyer P, Tönshoff B, Pape L. Favorable Outcome After Single-kidney Transplantation From Small Donors in Children: A Match-controlled CERTAIN Registry Study. Transplantation 2024; 108:1793-1801. [PMID: 38685197 DOI: 10.1097/tp.0000000000004993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
BACKGROUND Kidney transplantation (KTx) from small donors is associated with inferior graft survival in registry studies, whereas single-center studies show favorable results. METHODS We compared 175 pediatric KTx from small donors ≤20 kg (SDKTx) with 170 age-matched recipients from adult donors (ADKTx) from 20 centers within the Cooperative European Paediatric Renal Transplant Initiative registry. Graft survival and estimated glomerular filtration rate (eGFR) were analyzed by Cox regression and mixed models. Detailed data on surgical and medical management were tested for association with graft survival. RESULTS One-year graft survival was lower after SDKTx compared with ADKTx (90.9% versus 96.5%; odds ratio of graft loss, 2.92; 95% confidence interval [CI], 1.10-7.80; P = 0.032), but 5-y graft survival was comparable (90.9% versus 92.7%; adjusted hazard ratio of graft loss 1.9; 95% CI, 0.85-4.25; P = 0.119). SDKTx recipients had an annual eGFR increase of 8.7 ± 6.2 mL/min/1.73 m² compared with a decrease of 6.9 ± 5.7 mL/min/1.73 m² in ADKTx recipients resulting in a superior 5-y eGFR (80.5 ± 25.5 in SDKTx versus 65.7 ± 23.1 mL/min/1.73 m² in ADKTx; P = 0.008). At 3 y posttransplant, eGFR after single SDKTx was lower than after en bloc SDKTx (86.6 ± 20.4 versus 104.6 ± 35.9; P = 0.043) but superior to ADKTx (68.1 ± 23.9 mL/min/1.73 m²). Single-kidney SDKTx recipients had a lower rate of hypertension at 3 y than ADKTx recipients (40.0% versus 64.7%; P = 0.008). CONCLUSIONS Compared with ADKTx, 5-y graft function is superior in SDKTx and graft survival is similar, even when performed as single KTx. Utilizing small donor organs, preferably as single kidneys in experienced centers, is a viable option to increase the donor pool for pediatric recipients.
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Affiliation(s)
- Raphael Schild
- Department of Pediatric Nephrology, Pediatric Hepatology and Pediatric Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Karla Carvajal Abreu
- Department of Pediatrics, University Children's Hospital, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anja Büscher
- Department of Pediatrics II, University Hospital of Essen, University of Essen-Duisburg, Essen, Germany
| | - Nele Kanzelmeyer
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany
| | - Susanne Lezius
- Department of Medical Biometry and Epidemiology, University Medical Center, Hamburg-Eppendorf, Germany
| | - Kai Krupka
- Department of Pediatrics I, University Children's Hospital, Heidelberg, Germany
| | - Marcus Weitz
- Department of General Pediatrics and Hematology/Oncology, University Children's Hospital Tübingen, Tübingen, Germany
| | - Agnieszka Prytula
- Paediatric Nephrology and Rheumatology Department, Ghent University Hospital, Ghent, Belgium
| | - Nikoleta Printza
- Pediatric Nephrology Unit, First Department of Pediatrics, Hippokratio General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - László Berta
- First Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Seha Kamil Saygili
- Division of Pediatric Nephrology, Department of Pediatrics, İstanbul University-Cerrahpaşa, Cerrahpaşa School of Medicine, Istanbul, Turkey
| | - Anne-Laure Sellier-Leclerc
- Centre de Référence des Maladies Rénales Rares, Service de Néphrologie Pédiatrique, Hôpital Femme Mère Enfant, HCL, Bron Cedex, France
| | - Giuseppina Spartà
- Pediatric Nephrology, University Children's Hospital Zürich, Zurich, Switzerland
| | - Stephen D Marks
- Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Markus J Kemper
- Department of Pediatrics, Asklepios Klinik Nord Heidberg, Hamburg, Germany
| | - Sabine König
- Department of General Pediatrics, University Hospital Muenster, Muenster, Germany
| | - Rezan Topaloglu
- Department of Pediatric Nephrology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Dominik Müller
- Pediatric Nephrology, Charité Children's Hospital, Berlin, Germany
| | - Günter Klaus
- Department of Pediatrics II, University Children's Hospital, Philipps-University Marburg, Marburg, Germany
| | - Stefanie Weber
- Department of Pediatrics II, University Children's Hospital, Philipps-University Marburg, Marburg, Germany
| | - Jun Oh
- Department of Pediatric Nephrology, Pediatric Hepatology and Pediatric Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Uta Herden
- Department of Visceral Transplantation, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Andrea Carraro
- Pediatric Nephrology, Dialysis and Transplant Unit, Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
| | - Luca Dello Strologo
- Renal Transplant Unit, Bambino Gesù Children's Research Hospital IRCCS, Rome, Italy
| | - Gema Ariceta
- Division of Pediatric Nephrology, Hospital Universitari Vall d' Hebron, Barcelona, Spain
| | - Peter Hoyer
- Department of Pediatrics II, University Hospital of Essen, University of Essen-Duisburg, Essen, Germany
| | - Burkhard Tönshoff
- Department of Pediatrics I, University Children's Hospital, Heidelberg, Germany
| | - Lars Pape
- Department of Pediatrics II, University Hospital of Essen, University of Essen-Duisburg, Essen, Germany
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Lysakowski S, Druck Garcia C, Weisheimer Rohde R, Pascual Vitola S, Silva Pires F, Carla de Souza V, Enrico Ventura P, Kist R. Pediatric kidney transplantation: outcomes with under and over 6-year-old donors. J Pediatr (Rio J) 2024; 100:67-73. [PMID: 37591483 PMCID: PMC10751696 DOI: 10.1016/j.jped.2023.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 07/10/2023] [Accepted: 07/18/2023] [Indexed: 08/19/2023] Open
Abstract
OBJECTIVE Kidney shortage for pediatric kidney transplantation (PKT) entails the need to use low-weight and age donors, despite the apprehension. The aim of this study was to analyze the pediatric deceased donor kidney transplantations (pDDKT) outcomes in the first year after the procedure, stratified by donor age. METHOD Retrospective cohort of pDDKTs carried out between January 2013, and January 2018, at a PKT reference hospital in Southern Brazil. Donors were divided into group 1 (≤ 6 years), and group 2 (> 6 years); the analysis of the outcomes was carried out in the same period. RESULTS There were 143 pDDKTs; 51 (35.66%) in group 1; and 92 (64.34%) in group 2. In both groups there were 17 graft losses (11.8%), with vascular thrombosis as the main cause (group 1: 5; group 2: 4). Among the complications, renal artery stenosis (RAS) with indication for angioplasty and stenting was more frequent in group 1 (7.8%; group 2: 2.2%). The 1-year Renal Transplant Recipients' and graft survival did not show significant differences between the groups, (p = = 0.95). However, the Glomerular Filtration Rate analysis was higher in group 2, reaching, in the 12th month, 79.3 mL/min/1,73m2, compared to 69.7 mL/min/1,73m2 in group 1(p = = 0.033). CONCLUSIONS Small donors can be considered for pDDKTs, as long as there is an expert team to perform the transplantation.
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Affiliation(s)
- Simone Lysakowski
- Universidade Federal de Ciências da Saúde de Porto Alegre, Irmandade Santa Casa de Misericórdia de Porto Alegre, Programa de Pós-Graduação em Pediatria, Porto Alegre, RS, Brazil.
| | - Clotilde Druck Garcia
- Universidade Federal de Ciências da Saúde de Porto Alegre, Irmandade Santa Casa de Misericórdia de Porto Alegre, Programa de Pós-Graduação em Pediatria, Porto Alegre, RS, Brazil
| | - Roberta Weisheimer Rohde
- Universidade Federal de Ciências da Saúde de Porto Alegre, Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil
| | - Santo Pascual Vitola
- Universidade Federal de Ciências da Saúde de Porto Alegre, Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil
| | - Fabian Silva Pires
- Universidade Federal de Ciências da Saúde de Porto Alegre, Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil
| | | | - Pedro Enrico Ventura
- Universidade Federal de Ciências da Saúde de Porto Alegre, Graduação em Medicina, Porto Alegre, RS, Brazil
| | - Roger Kist
- Universidade Federal de Ciências da Saúde de Porto Alegre, Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil
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Gander R, Asensio M, Andrés Molino J, Fatou Royo G, Lopez-Gonzalez M, Perez V, López M, Ariceta G. Pediatric kidney retransplantation focused on surgical outcomes. J Pediatr Urol 2022; 18:847.e1-847.e9. [PMID: 35810139 DOI: 10.1016/j.jpurol.2022.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 05/23/2022] [Accepted: 06/17/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Despite survival rates after pediatric kidney transplantation (KT) are on the rise it is still likely that most pediatric recipients will require more than one retransplant in their lifetime. The earlier the age at the first KT the higher is the risk of repeat pediatric kidney transplantation (RPKT). OBJECTIVE The current study aims to analyze the outcomes of repeat pediatric kidney transplantation (RPKT) among pediatric kidney transplant recipients focusing on surgical complications and compare the outcomes of second and subsequent grafts with those of the first kidney graft. MATERIALS AND METHODS Retrospective study of RPKT (<18 years) undertaken between January 2000-2020. We analyzed primary etiology of renal disease, time to graft loss (GL), etiology of initial graft failure, history of acute rejection, previous delayed graft function, HLA-mismatches at the initial transplant, surgical complications and outcomes. Additionally, we compared the characteristics and outcomes of patients who underwent RPKT (group 1) with those who received a first kidney graft (group 2). RESULTS Out of 229 kT, 59 patients underwent RPKT (26 females/33 males). At the time of RPKT median age was 11.37 years (SD:5.7). The most frequent primary renal disease was congenital nephrotic syndrome in 11 (18.6%). Fifty-four (91.5%) were on renal replacement therapy at the time of transplant. Fourty-one patients received their second KT (69.5%), 14 (23.7%) the third, 3 (5.1%) the fourth and 1 (1.7%) the fifth. Transplant graft nephrectomy (GN) was performed in 26 patients (44.1%) prior to retransplantation. Fifty-four (91.5%) received a cadaveric graft and 5 (8.5%) a living-related graft. An extraperitoneal approach was achieved in 53 patients (89.8%), whereas in the remaining 6 (10.2%) the graft was placed intraperitoneally. We observed 10 surgical complications (16.9%): 9 major which required reintervention and 1 minor (perirenal hematoma). No vascular complications were observed and none of the surgical complications were involved in graft loss. Graft survival at 1,3 and 5 years was 91%, 84% and 73% respectively. The most frequent cause of GL was chronic graft nephropathy in 15 (25.4%). After a mean follow-up of 9.40 years (SD: 4.7) only 2 patients died (3.4%), both with functioning grafts. DISCUSSION Pediatric recipients of second and subsequent kidney grafts constitute a remarkable high-risk population but are becoming more frequent at reference pediatric transplant centers. CONCLUSIONS RPKT is technically challenging but can yield good results. In our series overall the incidence of surgical complications and particularly vascular complications was low.
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Affiliation(s)
- Romy Gander
- Department of Pediatric Surgery, Pediatric Urology and Renal Transplant Unit, University Hospital Vall d´Hebron Barcelona, Hospital Vall d´Hebron, Passeig de La Vall d´Hebrón 119-129, 08035 Barcelona, Spain; Universidad Autónoma de Barcelona, Hospital Vall d´Hebron. Passeig de La Vall d´Hebrón 119-129, 08035 Barcelona, Spain.
| | - Marino Asensio
- Department of Pediatric Surgery, Pediatric Urology and Renal Transplant Unit, University Hospital Vall d´Hebron Barcelona, Hospital Vall d´Hebron, Passeig de La Vall d´Hebrón 119-129, 08035 Barcelona, Spain
| | - Jose Andrés Molino
- Department of Pediatric Surgery, Pediatric Urology and Renal Transplant Unit, University Hospital Vall d´Hebron Barcelona, Hospital Vall d´Hebron, Passeig de La Vall d´Hebrón 119-129, 08035 Barcelona, Spain
| | - Gloria Fatou Royo
- Department of Pediatric Surgery, Pediatric Urology and Renal Transplant Unit, University Hospital Vall d´Hebron Barcelona, Hospital Vall d´Hebron, Passeig de La Vall d´Hebrón 119-129, 08035 Barcelona, Spain
| | - Mercedes Lopez-Gonzalez
- Department of Pediatric Nephrology, University Hospital Vall d´Hebron, Barcelona, Hospital Vall d´Hebron, Passeig de La Vall d´Hebrón 119-129, 08035 Barcelona, Spain
| | - Victor Perez
- Department of Pediatric Nephrology, University Hospital Vall d´Hebron, Barcelona, Hospital Vall d´Hebron, Passeig de La Vall d´Hebrón 119-129, 08035 Barcelona, Spain
| | - Manuel López
- Department of Pediatric Surgery, University Hospital Vall d´Hebron, Barcelona, Hospital Vall d´Hebron, Passeig de La Vall d´Hebrón 119-129, 08035 Barcelona, Spain; Universidad Autónoma de Barcelona, Hospital Vall d´Hebron. Passeig de La Vall d´Hebrón 119-129, 08035 Barcelona, Spain
| | - Gema Ariceta
- Department of Pediatric Nephrology, University Hospital Vall d´Hebron, Barcelona, Hospital Vall d´Hebron, Passeig de La Vall d´Hebrón 119-129, 08035 Barcelona, Spain; Universidad Autónoma de Barcelona, Hospital Vall d´Hebron. Passeig de La Vall d´Hebrón 119-129, 08035 Barcelona, Spain
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Cetiner M, Paul A, Treckmann JW, Dittmann S, Büscher R, Hoyer PF, Büscher AK. Small donors for small recipients - excellent growth and long-term function of single kidney grafts. Transpl Int 2021; 34:2735-2745. [PMID: 34626504 DOI: 10.1111/tri.14129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 08/23/2021] [Accepted: 09/10/2021] [Indexed: 12/26/2022]
Abstract
Small-donor kidneys (≤20 kg donor weight, SDK) are preferably transplanted en bloc in adults. Concerns about thrombotic complications or hyperfiltration hinder their use in children, particularly as single grafts. Low centre experience and donor-to-recipient size are rated critical regarding outcomes. We evaluated SDK transplantation (SDTx) in paediatric recipients at a specialized transplant centre. Between 2008 and 2018, SDTx was performed in 40 children (mean age 5.4 ± 1.4 years, single grafts n = 38, donor weight ≤10 kg: n = 10). Perioperative complications were rare (n = 3), mainly thromboses despite immediate heparinization and resulted in graft loss in one patient. Overall, early and long-term GFR were excellent (76 ± 21 and 100 ± 11 ml/min/1.73 m2 , first month and year 5, respectively). Three patients presented with delayed graft function. Graft volume increased significantly (69 ± 38 vs. 111 ± 33 ml within 5 years; P < 0.0001). Patients showed catch-up growth to normal range (SDS for height -2.06 ± 1.6 to -1.60 ± 1.5). Stratification by recipient age and donor weight revealed superior results in young recipients (≤3 years) and ≤10 kg donors, respectively. Outcome of single SDK grafts was excellent. Gain of GFR and graft volume was even higher in patients with very small donor or recipient size, regardless of a reduced donor-to-recipient weight ratio. Therefore, SDTx should be considered favouring small paediatric recipients.
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Affiliation(s)
- Metin Cetiner
- Paediatric Nephrology, University Children's Hospital, University Duisburg-Essen, Essen, Germany
| | - Andreas Paul
- General, Visceral and Transplantation Surgery, University Hospital Essen, Essen, Germany
| | - Juergen W Treckmann
- General, Visceral and Transplantation Surgery, University Hospital Essen, Essen, Germany
| | - Susanne Dittmann
- General, Visceral and Transplantation Surgery, University Hospital Essen, Essen, Germany
| | - Rainer Büscher
- Paediatric Nephrology, University Children's Hospital, University Duisburg-Essen, Essen, Germany
| | - Peter F Hoyer
- Paediatric Nephrology, University Children's Hospital, University Duisburg-Essen, Essen, Germany
| | - Anja K Büscher
- Paediatric Nephrology, University Children's Hospital, University Duisburg-Essen, Essen, Germany
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Outcome of kidney transplantation from young pediatric donors (aged less than 6 years) to young size-matched recipients. J Pediatr Urol 2019; 15:213-220. [PMID: 31005637 DOI: 10.1016/j.jpurol.2019.03.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 01/10/2019] [Accepted: 03/20/2019] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Pediatric donation is underutilized because of presumed increased risk of vascular thrombosis (VT) and graft loss. Using young pediatric donors (YPDs) for young pediatric recipients (YPRs) is suggested to be even at greater risk and therefore precluded in many centers. The aim of this study was to analyze the outcome of kidney transplantation (KT) from YPD to age-matched YPR. PATIENT AND METHODS A retrospective study of 118 pediatric KT performed between January 2007-July 2017. The authors identified KT with YPD (considered as those aged <6 years) and age-matched YPR. Organ allocation was performed based on the best paired size (YPR for YPR). Data were collected regarding donor and recipient characteristics, surgical and urological complications, graft loss, and outcomes. RESULTS Forty cases of YPD to age-matched YPR were identified (33.89% of the cohort). Mean recipient and donor age were 2.9 years (SD 1.68) and 2.24 years (SD 1.5), respectively. Mean recipient and donor weight were 12.7 kg (SD 4.1) and 13.7 kg (SD 4.15), respectively. Thirty of those young recipients (75%) weighed <15 kg. The most frequent primary renal disease was the congenital nephrotic syndrome. Nine out of 40 patients (22.5%) had received a previous KT before. Three received a combined liver-KT. Eight (20%) were classified as high immunological risk and 19 (47.5%) as high thrombotic risk. All allografts were implanted extraperitoneally and anastomosed to the iliac vessels. Major complications requiring reintervention occurred in seven patients (17.5%): three VT, three bleeding episodes, and one ureteral necrosis. Remarkably, only one surgical complication (VT) resulted in graft loss. Regarding long-term urological complications, four patients (10%) all with obstructive uropathy-developed vesicoureteral reflux to the graft. Actuarial graft survival at 1,5, and 10 years in the YPD to age-matched YPR cohort was 83% -78% -78%, respectively. Mean follow-up was 3.6 years (SD 3.2) (r = 7-10). Over time, eight patients lost their graft, not related to surgical factors in seven out of eight cases. CONCLUSION The authors suggest that KT using YPD for age-match YPR yields good results in expert centers, even in high-risk patients and is associated with good graft survival. In this series, surgical complications were rarely related to graft loss.
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Utilisation of small paediatric donor kidneys for transplantation. Pediatr Nephrol 2019; 34:1717-1726. [PMID: 30238149 PMCID: PMC6775037 DOI: 10.1007/s00467-018-4073-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 08/22/2018] [Accepted: 08/28/2018] [Indexed: 11/14/2022]
Abstract
With the increasing need for kidney transplantation in the paediatric population and changing donor demographics, children without a living donor option will potentially be offered an adult deceased donor transplant of marginal quality. Given the importance of long-term graft survival for paediatric recipients, consideration is now being given to kidneys from small paediatric donors (SPDs). There exist a lack of consensus and a reluctance amongst some centres in transplanting SPDs due to high surgical complication rates, graft loss and concerns regarding low nephron mass and long-term function. The aim of this review is to examine and present the evidence base regarding the transplantation of these organs. The literature in both the paediatric and adult renal transplant fields, as well as recent relevant conference proceedings, is reviewed. We discuss the surgical techniques, long-term graft function and rates of complications following transplantation of SPDs. We compare graft survival of SPDs to adult deceased donors and consider the use of small paediatric donors after circulatory death (DCD) organs. In conclusion, evidence is presented that may refute historically held paradigms regarding the transplantation of SPDs in paediatric recipients, thereby potentially allowing significant expansion of the donor pool.
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