1
|
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.
Collapse
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
| |
Collapse
|
2
|
Melk A, Sugianto RI, Zhang X, Dahhou M, Döhler B, Süsal C, Sapir-Pichhadze R, Wong G, Foster BJ. Influence of donor sex and age on graft outcome in kidney transplantation. Nephrol Dial Transplant 2024; 39:607-617. [PMID: 37596063 PMCID: PMC10966323 DOI: 10.1093/ndt/gfad181] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Indexed: 08/20/2023] Open
Abstract
BACKGROUND There is a known recipient sex-dependent association between donor sex and kidney transplant survival. We hypothesized that donor age also modifies the association between donor sex and graft survival. METHODS First, deceased donor kidney transplant recipients (1988-2019, n = 461 364) recorded in the Scientific Registry of Transplant Recipients, the Australia and New Zealand Dialysis and Transplant Registry and the Collaborative Transplant Study were analyzed. We used multivariable Cox regression models to estimate the association between donor sex and death censored graft loss, accounting for the modifying effects of recipient sex and donor age; donor age was categorized as 5-19, 20-34, 35-49, 50-59 and ≥60 years. Results from cohort-specific Cox models were combined using individual patient data meta-analysis. RESULTS Among female recipients of donors aged <60 years, graft loss hazards did not differ by donor sex; recipients of female donors ≥60 years showed significantly lower graft loss hazards than recipients of male donors of the same age [combined adjusted hazard ratio (aHR) 0.90, 95% CI 0.86-0.94]. Among male recipients, female donors aged <50 years were associated with significantly higher graft loss hazards than same-aged male donors (5-19 years: aHR 1.11, 95% CI 1.02-1.21; 20-34 years: aHR 1.08, 95% CI 1.02-1.15; 35-49 years: aHR 1.07, 95% CI 1.04-1.10). There were no significant differences in graft loss by donor sex among male recipients of donors aged ≥50 years. CONCLUSION Donor age modifies the association between donor sex and graft survival. Older female donors were associated with similar or lower hazards of graft failure than older male donors in both male and female recipients, suggesting a better functional reserve of older female donor kidneys.
Collapse
Affiliation(s)
- Anette Melk
- Children's Hospital, Hannover Medical School, Hannover, Germany
| | | | - Xun Zhang
- Research Institute of the McGill University Health Centre, Centre for Outcomes Research and Evaluation, Montréal, QC, Canada
| | - Mourad Dahhou
- Research Institute of the McGill University Health Centre, Centre for Outcomes Research and Evaluation, Montréal, QC, Canada
| | - Bernd Döhler
- Institute of Immunology, Heidelberg University Hospital, Heidelberg, Germany
| | - Caner Süsal
- Transplant Immunology Research Center of Excellence, Koç University, Istanbul, Turkey
| | - Ruth Sapir-Pichhadze
- Research Institute of the McGill University Health Centre, Centre for Outcomes Research and Evaluation, Montréal, QC, Canada
- Department of Medicine, Division of Nephrology, McGill University, Montréal, QC, Canada
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montréal, QC, Canada
| | - Germaine Wong
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Bethany J Foster
- Research Institute of the McGill University Health Centre, Centre for Outcomes Research and Evaluation, Montréal, QC, Canada
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montréal, QC, Canada
- Department of Pediatrics, Division of Nephrology, McGill University, Montréal, QC, Canada
| |
Collapse
|
3
|
Eastment JG, Ryan EG, Campbell S, Ray M, Viecelli AK, Jegatheesan D, Kanagarajah V, Griffin A, Preston JM, Johnson DW, Isbel N. Long-term Outcomes of Single and Dual En Bloc Kidney Transplants From Small Pediatric Donors: An ANZDATA Registry Study. Transplant Direct 2023; 9:e1518. [PMID: 37492077 PMCID: PMC10365191 DOI: 10.1097/txd.0000000000001518] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 02/20/2023] [Accepted: 02/25/2023] [Indexed: 07/27/2023] Open
Abstract
Kidney transplants from small pediatric donors are considered marginal and often transplanted as dual grafts. This study aimed to compare long-term outcomes between recipients of single kidney transplants (SKTs) and dual en bloc kidney transplants (EBKTs) from small pediatric donors. Methods Data were obtained from the Australia and New Zealand Dialysis and Transplant Registry. All adult recipients of kidney transplants from donors aged ≤5 y were identified. The primary outcome of interest was death-censored graft survival by donor type. The secondary outcomes were early graft loss, delayed graft function, serum creatinine posttransplantation, acute rejection, and patient survival. Results There were 183 adult recipients of kidney transplants from donors aged ≤5 y old. Of these, 60 patients had EBKT grafts, 79 patients had SKT grafts, and 44 patients had grafts of unknown type. Compared with SKT donors, EBKT donors had lower mean age (P < 0.001) and body weight (P < 0.001). There was no significant difference in death-censored graft survival between the groups, with median survival of 23.8 y (interquartile range 21.2-25) in the EBKT cohort and 21.8 y (11.6-26.8) in the SKT cohort (hazard ratio 1.3; 95% confidence interval, 0.59-2.64; P = 0.56). EBKT grafts had lower acute rejection rates than SKT grafts (P = 0.014). There was no significant difference observed between groups with respect to early graft loss, delayed graft function, posttransplantation serum creatinine posttransplantation, or patient survival. Conclusions EBKT and SKTs from small pediatric donors are associated with excellent long-term graft survival rates.
Collapse
Affiliation(s)
- Jacques G Eastment
- Queensland Kidney Transplant Service, Princess Alexandra Hospital, Brisbane, Australia
- School of Medicine, University of Queensland, Brisbane, Australia
| | - Elizabeth G Ryan
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- QCIF Facility for Advanced Bioinformatics, Institute for Molecular Bioscience, The University of Queensland, Brisbane, Australia
| | - Scott Campbell
- Queensland Kidney Transplant Service, Princess Alexandra Hospital, Brisbane, Australia
- School of Medicine, University of Queensland, Brisbane, Australia
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
- Translational Research Institute, Brisbane, Australia
- Centre for Kidney Disease Research, University of Queensland, Brisbane, Australia
| | - Mark Ray
- Queensland Kidney Transplant Service, Princess Alexandra Hospital, Brisbane, Australia
- School of Medicine, University of Queensland, Brisbane, Australia
| | - Andrea K Viecelli
- Queensland Kidney Transplant Service, Princess Alexandra Hospital, Brisbane, Australia
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
- Translational Research Institute, Brisbane, Australia
| | - Dev Jegatheesan
- Queensland Kidney Transplant Service, Princess Alexandra Hospital, Brisbane, Australia
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
- Centre for Kidney Disease Research, University of Queensland, Brisbane, Australia
| | - Vijay Kanagarajah
- Queensland Kidney Transplant Service, Princess Alexandra Hospital, Brisbane, Australia
- School of Medicine, University of Queensland, Brisbane, Australia
| | - Anthony Griffin
- Queensland Kidney Transplant Service, Princess Alexandra Hospital, Brisbane, Australia
- School of Medicine, University of Queensland, Brisbane, Australia
| | - John M Preston
- Queensland Kidney Transplant Service, Princess Alexandra Hospital, Brisbane, Australia
- School of Medicine, University of Queensland, Brisbane, Australia
| | - David W Johnson
- Queensland Kidney Transplant Service, Princess Alexandra Hospital, Brisbane, Australia
- School of Medicine, University of Queensland, Brisbane, Australia
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
- Translational Research Institute, Brisbane, Australia
- Centre for Kidney Disease Research, University of Queensland, Brisbane, Australia
| | - Nicole Isbel
- Queensland Kidney Transplant Service, Princess Alexandra Hospital, Brisbane, Australia
- School of Medicine, University of Queensland, Brisbane, Australia
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
- Translational Research Institute, Brisbane, Australia
- Centre for Kidney Disease Research, University of Queensland, Brisbane, Australia
| |
Collapse
|
4
|
Burkhalter F, Holzmann Y, Georgalis A, Wehmeier C, Hirt-Minkowski P, Hoenger G, Hopfer H, Guerke L, Steiger J, Schaub S, Amico P. Excellent Clinical Long-Term Outcomes of Kidney Transplantation From Small Pediatric Donors (Age ≤ 5 Years) Despite Early Hyperfiltration Injury. Can J Kidney Health Dis 2023; 10:20543581231160004. [PMID: 37009424 PMCID: PMC10052475 DOI: 10.1177/20543581231160004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 01/13/2023] [Indexed: 03/30/2023] Open
Abstract
Background: The use of small pediatric donors (age ≤ 5 years and body weight < 20kg) for adult transplant recipients is still regarded controversially in terms of early complications, long-term outcomes, and development of hyperfiltration injury due to body size mismatch. Objective: To investigate long-term outcomes of adult renal allograft recipients receiving a kidney from small pediatric donor (SPD) in terms of kidney function and early features of hyperfiltration injury such as histological changes and proteinuria. Design: Retrospective, single center study. Settings: Transplant center of the University Hospital of Basel, Switzerland. Patients: Adult renal allograft recipients receiving a kidney from a small pediatric donor at our center between 2005 and 2017. Methods: The outcome of 47 transplants from SPD were compared with 153 kidney transplants from deceased-standard criteria donors (SCD) occurring during the same time period. Incidence of clinical signs of hyperfiltration injury (eg, proteinuria) was investigated. According to our policy, surveillance biopsies were taken at 3 and 6 months post-transplant and were evaluated in terms of signs of hyperfiltration injury. Results: At a median follow-up of 2.3 years post-transplant, death-censored graft survival of SPD was comparable to transplants from SCD (94% vs 93%; P = .54). Furthermore, allograft function at last follow-up (estimated glomerular filtration rate–Modification of Diet in Renal Disease) was significantly higher in pediatric transplant (80 vs 55 ml/min/1.73 m2, P = .002). We found histological signs of early hyperfiltration injury in 55% of SPD. There was an equally low proteinuria in both groups during follow-up. Limitations: It is a single center and retrospective observational study with small sample size. The outcomes were investigated in a well-selected population of recipients with low body mass index, low immunological risk, and well-controlled hypertension and was not compared with equal selected group of recipients. Conclusions: Early histological and clinical signs of hyperfiltration injury in SPD is frequent. Despite the hyperfiltration injury, there is an equal allograft survival and even superior allograft function in SPD compared with SCD during follow-up. This observation supports the concept of high adaptive capacity of pediatric donor kidneys.
Collapse
Affiliation(s)
- Felix Burkhalter
- Division of Nephrology, University Clinic of Medicine, Kantonsspital Baselland, Liestal, Switzerland
- Felix Burkhalter, Division of Nephrology, University Clinic of Medicine, Kantonsspital Baselland, Rheinstrasse 26, Liestal 4410, Switzerland.
| | - Yvonne Holzmann
- Division of Nephrology, University Clinic of Medicine, Kantonsspital Baselland, Liestal, Switzerland
| | - Argyrios Georgalis
- Transplantation Immunology & Nephrology, University Hospital Basel, Basel, Switzerland
| | - Caroline Wehmeier
- Transplantation Immunology & Nephrology, University Hospital Basel, Basel, Switzerland
| | | | - Gideon Hoenger
- Transplantation Immunology & Nephrology, University Hospital Basel, Basel, Switzerland
| | - Helmut Hopfer
- Institute for Pathology, University Hospital Basel, Basel, Switzerland
| | - Lorenz Guerke
- Department of Vascular and Transplant Surgery, University Hospital Basel, Basel, Switzerland
| | - Juerg Steiger
- Transplantation Immunology & Nephrology, University Hospital Basel, Basel, Switzerland
| | - Stefan Schaub
- Transplantation Immunology & Nephrology, University Hospital Basel, Basel, Switzerland
| | - Patrizia Amico
- Transplantation Immunology & Nephrology, University Hospital Basel, Basel, Switzerland
| |
Collapse
|
5
|
Clinical Phenotypes of Dual Kidney Transplant Recipients in the United States as Identified through Machine Learning Consensus Clustering. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58121831. [PMID: 36557033 PMCID: PMC9783488 DOI: 10.3390/medicina58121831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 12/03/2022] [Accepted: 12/09/2022] [Indexed: 12/14/2022]
Abstract
Background and Objectives: Our study aimed to cluster dual kidney transplant recipients using an unsupervised machine learning approach to characterize donors and recipients better and to compare the survival outcomes across these various clusters. Materials and Methods: We performed consensus cluster analysis based on recipient-, donor-, and transplant-related characteristics in 2821 dual kidney transplant recipients from 2010 to 2019 in the OPTN/UNOS database. We determined the important characteristics of each assigned cluster and compared the post-transplant outcomes between clusters. Results: Two clinically distinct clusters were identified by consensus cluster analysis. Cluster 1 patients was characterized by younger patients (mean recipient age 49 ± 13 years) who received dual kidney transplant from pediatric (mean donor age 3 ± 8 years) non-expanded criteria deceased donor (100% non-ECD). In contrast, Cluster 2 patients were characterized by older patients (mean recipient age 63 ± 9 years) who received dual kidney transplant from adult (mean donor age 59 ± 11 years) donor with high kidney donor profile index (KDPI) score (59% had KDPI ≥ 85). Cluster 1 had higher patient survival (98.0% vs. 94.6% at 1 year, and 92.1% vs. 76.3% at 5 years), and lower acute rejection (4.2% vs. 6.1% within 1 year), when compared to cluster 2. Death-censored graft survival was comparable between two groups (93.5% vs. 94.9% at 1 year, and 89.2% vs. 84.8% at 5 years). Conclusions: In summary, DKT in the United States remains uncommon. Two clusters, based on specific recipient and donor characteristics, were identified through an unsupervised machine learning approach. Despite varying differences in donor and recipient age between the two clusters, death-censored graft survival was excellent and comparable. Broader utilization of DKT from high KDPI kidneys and pediatric en bloc kidneys should be encouraged to better address the ongoing organ shortage.
Collapse
|
6
|
Seizilles de Mazancourt E, Badet L, Codas Duarte R, Morelon E, Crouzet S, Terrier N, Matillon X. En Bloc Kidney Transplantation: A Retrospective Study of an 18-year Experience in a Single Institution. EUR UROL SUPPL 2022; 46:137-144. [PMID: 36506250 PMCID: PMC9732470 DOI: 10.1016/j.euros.2022.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2022] [Indexed: 11/17/2022] Open
Abstract
Background Renal transplantation is facing a shortage of grafts. En bloc kidney transplantation (EBKT) from pediatric donors could increase the number of available grafts. Objective To describe the surgical technique as well as the long-term functional and morphological results of EBKT. Design setting and participants We performed a retrospective study of all the EBKT procedures performed in Lyon between 2002 and 2020. Electronic medical records were checked with an analysis of demographics, and peri- and postoperative results. Outcome measurements and statistical analysis A descriptive analysis of donor and recipient characteristics, perioperative data, complications, and renal function was performed. Results and limitations Between 2002 and 2020, 21 EBKT procedures were performed. Donors had a mean weight of 8.6 kg and a mean age of 12 mo, with a mean cold ischemia time of 11 h and 30 min. Receivers had a mean age of 30 yr and a body mass index of 20. The mean follow-up time was 62 mo, with patient survival of 100% and graft survival of 95%. There were 13 reinterventions comprising one early unilateral transplantectomy for thrombosis. Renal function was excellent, and the morphological findings described an important growth in size in the first 2 yr before attaining the adult size. This study's limitations include its retrospective nature and a small number of participants. Conclusions The present study reports excellent results with EBKT and supports the pursuit and spread of this technique. Patient summary In this report, we describe the technique and results of en bloc kidney transplantation. We found that results are excellent for renal function and patient survival. We conclude that en bloc kidney transplantation should be considered to increase the number of grafts.
Collapse
Affiliation(s)
- Emilien Seizilles de Mazancourt
- Department of Urology Surgery and Transplantation, Edouard Herriot Hospital, Lyon, France,Corresponding author. Department of Urology Surgery and Transplantation, Edouard Herriot Hospital, Lyon, France. Tel. +33662431639.
| | - Lionel Badet
- Department of Urology Surgery and Transplantation, Edouard Herriot Hospital, Lyon, France
| | - Ricardo Codas Duarte
- Department of Urology Surgery and Transplantation, Edouard Herriot Hospital, Lyon, France
| | - Emmanuel Morelon
- Department of Transplantation, Nephrology and Immunology, Hospices Civils de Lyon, Lyon, France
| | - Sebastien Crouzet
- Department of Urology Surgery and Transplantation, Edouard Herriot Hospital, Lyon, France
| | | | - Xavier Matillon
- Department of Urology Surgery and Transplantation, Edouard Herriot Hospital, Lyon, France
| |
Collapse
|
7
|
de Santis Feltran L, Genzani CP, Hamamoto F, Fonseca MJBM, de Camargo MFC, de Oliveira NLG, de Freitas Amaral FC, Baptista JC, Koch Nogueira PC. Encouraging outcomes of using a small-donor single graft in pediatric kidney transplantation. Pediatr Nephrol 2022; 37:1137-1147. [PMID: 34651246 DOI: 10.1007/s00467-021-05296-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 08/31/2021] [Accepted: 09/01/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND The use of small pediatric kidneys as single grafts for transplantation is controversial, due to the potential risk for graft thrombosis and insufficient nephron mass. METHODS Aiming to test the benefits of transplanting these kidneys, 375 children who underwent kidney transplantation in a single center were evaluated: 49 (13.1%) received a single graft from a small pediatric donor (≤ 15 kg, SPD group), 244 (65.1%) from a bigger pediatric donor (> 15 kg, BPD group), and 82 (21.9%) from adult living donors (group ALD). RESULTS Groups had similar baseline main characteristics. After 5 years of follow-up, children from the SPD group were comparable to children from BPD and ALD in patient survival (94%, 96%, and 98%, respectively, p = 0.423); graft survival (89%, 88%, and 93%, respectively, p = 0.426); the frequency of acute rejection (p = 0.998); the incidence of post-transplant lymphoproliferative disease (p = 0.671); the odds ratio for severely increased proteinuria (p = 0.357); the rates of vascular thrombosis (p = 0.846); and the necessity for post-transplant surgical intervention prior to discharge (p = 0.905). The longitudinal evolution of eGFR was not uniform among groups. The three groups presented a decrease in eGFR, but the slope of the curve was steeper in ALD children. At 5 years, the eGFR of the ALD group was 10 ml/min/1.73m2 inferior to the others. At that time, the eGFR from the SPD group was statistically similar to the BPD group (p = 0.952). CONCLUSION In a specialized transplant center, the use of a single small pediatric donor kidney for transplantation is as successful as bigger pediatric or adult living donors, after 5 years of follow-up. A higher resolution version of the Graphical abstract is available as Supplementary information.
Collapse
Affiliation(s)
- Luciana de Santis Feltran
- Department of Pediatric Kidney Transplantation, Hospital Samaritano de São Paulo, Rua Guapiaçu 121-91, São Paulo, SP, 04024-020, Brazil.
| | - Camila Penteado Genzani
- Department of Pediatric Kidney Transplantation, Hospital Samaritano de São Paulo, Rua Guapiaçu 121-91, São Paulo, SP, 04024-020, Brazil
| | - Fernando Hamamoto
- Department of Pediatric Kidney Transplantation, Hospital Samaritano de São Paulo, Rua Guapiaçu 121-91, São Paulo, SP, 04024-020, Brazil
| | | | | | - Nara Léia Gelle de Oliveira
- Department of Pediatric Kidney Transplantation, Hospital Samaritano de São Paulo, Rua Guapiaçu 121-91, São Paulo, SP, 04024-020, Brazil
| | - Fabio Cabral de Freitas Amaral
- Department of Pediatric Kidney Transplantation, Hospital Samaritano de São Paulo, Rua Guapiaçu 121-91, São Paulo, SP, 04024-020, Brazil
| | - Jose Carlos Baptista
- Department of Vascular Surgery, Federal University of São Paulo, UNIFESP, São Paulo, Brazil
| | - Paulo Cesar Koch Nogueira
- Department of Pediatric Kidney Transplantation, Hospital Samaritano de São Paulo, São Paulo, Brazil.,Department of Pediatrics, Federal University of São Paulo, UNIFESP, São Paulo, Brazil
| |
Collapse
|
8
|
Sampaio MS, Lum EL, Homkrailas P, Gritsch HA, Bunnapradist S. Outcomes of small pediatric donor kidney transplants according to donor weight. Transpl Int 2021; 34:2403-2412. [PMID: 34431138 DOI: 10.1111/tri.14026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 08/05/2021] [Accepted: 08/13/2021] [Indexed: 11/27/2022]
Abstract
A small pediatric deceased donor (SPD) weight cutoff whether to transplant as en bloc (EB) or single pediatric (SP) kidney is uncertain. Using UNOS/OPTN data (2000-2019), 27 875 SPDs were divided by (i) EB (11.4%) or SP (88.6%) and (ii) donor weight [≤10 (5.4%), >10-15 (8.3%), >15-18 (3.7%), >18-20 (2.9%), and >20 kg (79.7%)]. SP >20 kg and adult deceased donors (grouped by Kidney Donor Profile Index, KDPI, <30, 30-85, and >85) were used as references. The primary outcome was 10-year graft failure. In SP <10 kg, the hazard ratio (HR) for overall graft failure was 1.64 (1.38-2.20) compared with EB <10 kg, and 1.45 (1.18-1.80) compared with SP >20 kg. In SP >10-15 kg, HR was 1.31 (1.12-1.54) compared with EB >10-15 kg, and 1.04 (0.91-1.18) compared with SP >20 kg. In SP >15 kg, the risk was the same as SP >20 kg. Ten-year overall graft survival of SP 12 kg was comparable to SP >20 kg (62% vs. 57%). Ten-year death censored graft failure of SP >10-15 kg (70%) and SP >15-18 kg (70%) was like the adult donors with KDPI 30-85 (67%). In conclusion, we recommend single kidney transplants from SPDs with weight >12 kg to adult recipients in centers with experience in SPD transplants to optimize organ utilization.
Collapse
Affiliation(s)
- Marcelo Santos Sampaio
- Department of Nephrology and Kidney Transplant, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA.,Department of Nephrology, Veterans Affairs Greater Los Angeles Medical Center, Los Angeles, CA, USA
| | - Erik Lawrence Lum
- Department of Nephrology and Kidney Transplant, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Piyavadee Homkrailas
- Department of Nephrology and Kidney Transplant, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Hans Albin Gritsch
- Department of Urology and Kidney Transplant, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Suphamai Bunnapradist
- Department of Nephrology and Kidney Transplant, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| |
Collapse
|
9
|
Gonzalez J, Tekin A, Vincenzi P, Alvarez A, Ciancio G. Transplantation of En Bloc Pediatric Kidneys With a Bladder Segment Patch After a Complex Vascular Reconstruction: A Case Report. Transplant Proc 2021; 53:2524-2528. [PMID: 34247862 DOI: 10.1016/j.transproceed.2021.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 05/02/2021] [Accepted: 06/01/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND En bloc pediatric kidney (EBPK) allografts represent one potential solution to increase the number of organs available in the donor pool, thus facilitating transplantation of kidneys from young donors into adult recipients. However, EBPK transplantation has been traditionally considered suboptimal because of concerns for perioperative complications. METHODS An extensive reconstruction and successful transplantation of an EBPK allograft using same pediatric donor vascular grafts and a bladder patch aiming to avoid postoperative complications is presented in this report. RESULTS The warm ischemia time was 25 minutes. No surgical drainage or ureteral stent were used. Postoperative Doppler ultrasound showed laminar blood flow and normal parameters in both the external iliac and graft arteries, no collections, and no signs of obstructive uropathy. The patient had an uneventful recovery showing a creatinine level of 0.86 mg/dL and 0.85 mg/dL at 1 month and 3 months, respectively. CONCLUSIONS A refined back-table reconstruction of these allografts is crucial to avoid mishaps in the postoperative period.
Collapse
Affiliation(s)
- Javier Gonzalez
- Department of Urology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Akin Tekin
- Department of Surgery, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, Florida; Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, Florida
| | - Paolo Vincenzi
- Department of Surgery, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, Florida; Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, Florida
| | - Angel Alvarez
- Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, Florida
| | - Gaetano Ciancio
- Department of Surgery, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, Florida; Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, Florida; Department of Urology, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, Florida.
| |
Collapse
|
10
|
Chen C, Su X, Wu C, Liu L, Zhang H, Deng R, Fu Q, Yuan X, Zheng Y, Qiu J, Chen G, Huang G, Deng S, Fei J, Chen L, Li J, Wang C. Successful single kidney transplantation from pediatric donors less than or equal to 10 kg to adult recipient: a retrospective cohort study. Transl Pediatr 2021; 10:1618-1629. [PMID: 34295776 PMCID: PMC8261586 DOI: 10.21037/tp-21-23] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 04/16/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Kidneys from very small pediatric donors (≤10 kg) are underutilized. Compared to en bloc kidney transplantation (EBKT), single kidney transplantation (SKT) can maximize donor resources. However, it remains unknown whether it's appropriate to perform SKTs from donors weighing ≤10 kg. METHODS A total of 35 adult recipients undergoing kidney transplantation from donors weighing ≤10 kg at our center from December 2014 to December 2019 were included and grouped into SKT group (n=20) and EBKT group (n=15). Transplant outcomes were retrospectively analyzed and compared between 2 groups. RESULTS The 1-year and 3-year death-censored graft survival in SKT group was 95%, it is not significantly higher than that in EBKT group (80%, log-rank test, P=0.38). Significant improvement in estimated glomerular filtration rate (eGFR) was noted in both groups, despite eGFR at 1 year was lower in the SKT group (P<0.01). Proteinuria was common in both groups but subsided gradually during the follow-up time. Complication rates were similar between 2 groups with no vascular thrombosis in the SKT group. CONCLUSIONS In conclusion, SKTs from donors weighing ≤10 kg to adult recipients achieves comparable outcomes with EBKTs, which provides evidence to support performing SKTs from donors weighing ≤10 kg in certain donor and recipient scenarios.
Collapse
Affiliation(s)
- Chuxiao Chen
- Organ Transplant Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xiaojun Su
- Organ Transplant Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Chenglin Wu
- Organ Transplant Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Longshan Liu
- Organ Transplant Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Huanxi Zhang
- Organ Transplant Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Ronghai Deng
- Organ Transplant Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Qian Fu
- Organ Transplant Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xiaopeng Yuan
- Organ Transplant Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yitao Zheng
- Organ Transplant Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jiang Qiu
- Organ Transplant Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Guodong Chen
- Organ Transplant Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Gang Huang
- Organ Transplant Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Suxiong Deng
- Organ Transplant Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jiguang Fei
- Organ Transplant Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Lizhong Chen
- Organ Transplant Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jun Li
- Organ Transplant Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Changxi Wang
- Organ Transplant Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, China.,Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, China
| |
Collapse
|
11
|
Vincenzi P, Alvarez A, Gonzalez J, Guerra G, Ciancio G. Transplantation of 2-Month-Old En Bloc Pediatric Kidneys After a Complex Vascular Reconstruction - Traveling 2500 Miles to Get Transplanted: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e931124. [PMID: 34016943 PMCID: PMC8147900 DOI: 10.12659/ajcr.931124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 04/14/2021] [Accepted: 04/05/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND En bloc pediatric kidneys (EBPK) are one potential solution to increase the number of organs available in the donor community, thus promoting transplantation of these allografts into adult recipients. However, EBPK transplantation has been traditionally considered suboptimal due to concerns for perioperative complications, mainly vascular thrombosis. We report an en bloc kidney transplantation using vascular grafts from another deceased donor to extend the EBPK aorta and vena cava and create a tension-free anastomosis with recipient external iliac vessels. CASE REPORT A pair of 2-month-old female en bloc kidneys weighting 6 kg were transplanted to a 30-year-old adult male. Prolonged cold ischemic time (CIT) was related to high refusal rate and long travel from Nevada to Miami. Prior to transplantation, the EBPK were connected to the LifePort Renal Preservation Machine® and deemed transplantable only after showing a significant improvement in perfusion parameters. Back-table reconstruction was conducted through an end-to-end anastomosis between an adult deceased donor common iliac artery and vein grafts to the inferior vena cava and aortic distal ends, respectively. The patient displayed immediate graft function (IGF) without any postoperative complications, showing a creatinine of 1.5 mg/dl at 4-month follow-up. CONCLUSIONS Use of renal preservation machine (RPM) and refined back-table reconstruction of these allografts are important tools to improve the significant discard rate and improve outcomes of EBPK.
Collapse
Affiliation(s)
- Paolo Vincenzi
- Department of Surgery, Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, U.S.A
| | - Angel Alvarez
- Department of Surgery, Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, U.S.A
| | - Javier Gonzalez
- Department of Urology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Giselle Guerra
- Department of Medicine, Division of Nephrology, Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, U.S.A
| | - Gaetano Ciancio
- Department of Surgery, Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, U.S.A
- Department of Urology, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, U.S.A
| |
Collapse
|
12
|
Das DM, Heilman RL, Khamash HA, Mathur AK, Singer AL, Reddy KS, Jadlowiec CC. Overcoming Mismatch Concerns for Adult Recipients of Small Pediatric Deceased Donor Kidneys. Transplant Proc 2021; 53:1509-1513. [PMID: 33892934 DOI: 10.1016/j.transproceed.2021.03.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 02/11/2021] [Accepted: 03/10/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Kidneys from very young pediatric donors continue to be underutilized. To reduce discard, the Organ Procurement and Transplantation Network (OPTN) policy was recently updated to allow kidneys from donors weighing <18 kg to be recovered en bloc. METHODS We reviewed our center's experience with kidney transplantation in adult recipients of <18 kg pediatric donor kidneys to assess renal function outcomes specific to solitary vs en bloc usage. RESULTS The majority of <18 kg donors were used en bloc (n = 39, 72.2% vs n = 15, 27.8%). Donor weight (kg) was similar between the 2 groups (12.3 ± 3.2 vs 14.1 ± 2.5, P = .05). Recipient weight was lower in the solitary kidney group (P = .01). Both groups had a similar donor-to-recipient body weight ratio (0.24 ± 0.3 vs 0.18 ± 0.3, P = .51). The solitary kidney group had a lower estimated glomerular filtration rate at 1 (56.9 ± 24.3 vs 81.8 ± 24.8, P = .01) and 2 years (72 ± 18.6 vs 93.7 ± 21.6, P = .03). By 2 years, both groups had an average estimated glomerular filtration rate >60 mL/min. Kidney allograft growth occurred in both groups, with the largest increase occurring the first month posttransplant (11.9%, 18.6%, P < .0001). CONCLUSION For pediatric donors weighing <18 kg, improvements in renal function continue beyond the first posttransplant year. Risk for hyperfiltration injury appears low and renal mass-recipient mass matching is useful in guiding decision-making for solitary vs en bloc utilization.
Collapse
Affiliation(s)
- Devika M Das
- Mayo Clinic Alix School of Medicine, Scottsdale, Arizona
| | | | | | - Amit K Mathur
- Division of Transplant Surgery, Mayo Clinic, Phoenix, Arizona
| | - Andrew L Singer
- Division of Transplant Surgery, Mayo Clinic, Phoenix, Arizona
| | - Kunam S Reddy
- Division of Transplant Surgery, Mayo Clinic, Phoenix, Arizona
| | | |
Collapse
|
13
|
Raza S, Alahmadi I, Broering D, Alherbish A, Ali T. Kidney transplantation in low weight pediatric recipients from adult donors: The short- And the long-term outcomes. Pediatr Transplant 2021; 25:e13860. [PMID: 33022859 DOI: 10.1111/petr.13860] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 05/26/2020] [Accepted: 08/28/2020] [Indexed: 11/25/2022]
Abstract
Pediatric patients with end-stage renal disease wait longer for KT due to shortage of organs and ultra-selection of donors so that they are age- and size-matched. KT from adult donors is reported to be associated with technical difficulties, complications, and poorer graft survival. We aimed to determine the outcomes of low weight patients who received kidneys from adult donors through extraperitoneal approach. We perform around 40 pediatric transplants/year, mostly from adult donors. Patients were divided into the (LWC: weight < 15 kg) and (HWC: ≥15 kg). From January 2011 to June 2017, 213 patients received KT. KT procedures were performed through extraperitoneal approach. Mean age of recipients was 10 years (5 years and 12 years for LWC and HWC, respectively) and 32 years for donors. Mean weight of recipient was 26 kg (13 kg and 31 kg for LWC and HWC, respectively) and 70 kg for donors. Mean follow-up was 5.5 years. Acute rejection occurred in 18% and delayed graft function in 5%. Three patients died during follow-up. Graft survival at 1 year was 97% and 82% at 5 years. Length of stay (P = .57), surgical complications (P = .74), long-term graft survival (P = .35), and GFR at 5 years (P = .59) were similar in both groups. This study shows that low weight pediatric patients can be transplanted from adult donors with low surgical complications and with favorable patient and graft survival. Extraperitoneal approach is feasible and safe in low weight recipients.
Collapse
Affiliation(s)
- Syed Raza
- King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Ibrahim Alahmadi
- King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Dieter Broering
- King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Adi Alherbish
- King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia.,King Khalid University Hospital, Riyadh, Saudi Arabia
| | - Tariq Ali
- King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| |
Collapse
|
14
|
Beetz O, Weigle CA, Nogly R, Klempnauer J, Pape L, Richter N, Vondran FWR. Surgical complications in pediatric kidney transplantation-Incidence, risk factors, and effects on graft survival: A retrospective single-center study. Pediatr Transplant 2021; 25:e13871. [PMID: 33053269 DOI: 10.1111/petr.13871] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 08/12/2020] [Accepted: 09/08/2020] [Indexed: 12/26/2022]
Abstract
The field of pediatric kidney transplantation remains challenging due to an ongoing lack of size-matched grafts and anatomical peculiarities. In the current study, we investigated the incidence of surgical complications in pediatric recipients, with a focus on risk factors and effects on graft outcome. We retrospectively reviewed all 2386 kidney transplantations at our institution from January 2005 until December 2018. Of these, 221 transplants were performed in pediatric recipients, defined as under the age of 18 years. Donor-recipient body surface area ratios were calculated to evaluate the effects of size mismatching. Regression analyses were performed to identify independent risk factors for surgical complications and graft survival, respectively. Perioperative surgical complications requiring revision were observed in 34 (15.4%) cases. Leading cause for revision were vascular complications such as thrombosis or stenosis (n = 15 [6.8%]), which were significantly more frequent in case of young donors, (ie, donor age <6 years; OR: 4.281; CI-95%:1.385-13.226; P = .012), previous nephrectomy (OR: 3.407; CI-95%:1.019-11.387; P = .046), and en-bloc grafts (OR: 4.923; CI-95%:1.355-17.884; P = .015), followed by postoperative hemorrhage (n = 10 [4.5%]), ureteral complications (n = 8 [3.6%]), and lymphoceles (n = 7 [3.2%]). Median follow-up was 84.13 (0.92-175.72) months. One-, 5-, and 10-year graft survival rates were 97.1%, 88.9%, and 65.1%, respectively. Except for vascular complications (HR: 4.727; CI-95%:1.363-16.394; P = .014), none of the analyzed surgical morbidities significantly influenced graft survival. In conclusion, pediatric kidney transplantation achieves excellent long-term results. However, meticulous surgical technique and continuous postoperative monitoring are imperative for early detection and treatment of imminent vascular complications, especially in case of young donors and en-bloc grafts.
Collapse
Affiliation(s)
- Oliver Beetz
- Department of General, Visceral and Transplant Surgery, Hannover Medical School, Hannover, Germany
| | - Clara A Weigle
- Department of General, Visceral and Transplant Surgery, Hannover Medical School, Hannover, Germany
| | - Rabea Nogly
- Department of General, Visceral and Transplant Surgery, Hannover Medical School, Hannover, Germany
| | - Jürgen Klempnauer
- Department of General, Visceral and Transplant Surgery, Hannover Medical School, Hannover, Germany
| | - Lars Pape
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany
| | - Nicolas Richter
- Department of General, Visceral and Transplant Surgery, Hannover Medical School, Hannover, Germany
| | - Florian W R Vondran
- Department of General, Visceral and Transplant Surgery, Hannover Medical School, Hannover, Germany
| |
Collapse
|
15
|
Yao J, Clayton PA, Wyburn K, Choksi H, Cavazzoni E, Tovmassian D, Lau HMH, Allen R, Yuen L, Laurence JM, Lam VWT, Pleass HCC. Paediatric kidney transplants from donors aged 1 year and under: an analysis of the Australian and New Zealand Dialysis and Transplant Registry from 1963 to 2018. Transpl Int 2020; 34:118-126. [PMID: 33067898 DOI: 10.1111/tri.13772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 04/20/2020] [Accepted: 10/11/2020] [Indexed: 11/30/2022]
Abstract
Kidneys from very small donors have the potential to significantly expand the donor pool. We describe the collective experience of transplantation using kidneys from donors aged ≤1 year in Australian and New Zealand. The ANZDATA registry was analysed on all deceased donor kidney transplants from donors aged ≤1 year. We compared recipient characteristics and outcomes between 1963-1999 and 2000-2018. From 1963 to 1999, 16 transplants were performed [9 (56%) adults, 7 (44%) children]. Death-censored graft survival was 50% and 43% at 1 and 5 years, respectively. Patient survival was 90% and 87% at 1 and 5 years, respectively. From 2000 to 2018, 26 transplants were performed [25 (96%) adults, 1 (4%) children]. Mean creatinine was 73 µmol/l ±49.1 at 5 years. Death-censored graft survival was 85% at 1 and 5 years. Patient survival was 100% at 1 and 5 years. Thrombosis was the cause of graft loss in 12% of recipients in the first era from 1963 to 1999, and 8% of recipients in the second era from 2000 to 2018. We advocate the judicious use of these small paediatric grafts from donors ≤1 year old. Optimal selection of donor and recipients may lead to greater acceptance and success of transplantation from very young donors.
Collapse
Affiliation(s)
- Jinna Yao
- National Pancreas Transplant Unit, Westmead Hospital, Sydney, NSW, Australia.,Department of Urology, Westmead Hospital, Sydney, NSW, Australia.,Faculty of Medicine and Health, University of Sydney Medical School, Camperdown, NSW, Australia
| | - Philip A Clayton
- Department of Medicine, The University of Adelaide, Adelaide, SA, Australia.,Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia.,Central and Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Kate Wyburn
- Faculty of Medicine and Health, University of Sydney Medical School, Camperdown, NSW, Australia.,Department of Renal Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Harsham Choksi
- Faculty of Medicine and Health, University of Sydney Medical School, Camperdown, NSW, Australia
| | - Elena Cavazzoni
- NSW Organ and Tissue Donation Service, Sydney, NSW, Australia.,Paediatric Intensive Care Unit, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - David Tovmassian
- National Pancreas Transplant Unit, Westmead Hospital, Sydney, NSW, Australia
| | - Howard M H Lau
- National Pancreas Transplant Unit, Westmead Hospital, Sydney, NSW, Australia.,Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia.,School of Medicine, Western Sydney University, Sydney, Australia
| | - Richard Allen
- National Pancreas Transplant Unit, Westmead Hospital, Sydney, NSW, Australia.,Faculty of Medicine and Health, University of Sydney Medical School, Camperdown, NSW, Australia
| | - Lawrence Yuen
- National Pancreas Transplant Unit, Westmead Hospital, Sydney, NSW, Australia.,Faculty of Medicine and Health, University of Sydney Medical School, Camperdown, NSW, Australia
| | - Jerome M Laurence
- Faculty of Medicine and Health, University of Sydney Medical School, Camperdown, NSW, Australia.,Department of Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Vincent W T Lam
- National Pancreas Transplant Unit, Westmead Hospital, Sydney, NSW, Australia.,Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
| | - Henry C C Pleass
- National Pancreas Transplant Unit, Westmead Hospital, Sydney, NSW, Australia.,Faculty of Medicine and Health, University of Sydney Medical School, Camperdown, NSW, Australia
| |
Collapse
|
16
|
Successful Single-kidney Transplantation in Adult Recipients Using Pediatric Donors Aged 8 to 36 Months: Comparable Outcomes With Those Using Pediatric Donors Aged >3 Years. Transplantation 2020; 103:2388-2396. [PMID: 30801522 DOI: 10.1097/tp.0000000000002618] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Using pediatric donors for single-kidney transplantation (SKT) can increase the number of possible recipients. However, it is unclear when SKT involving small pediatric donors and adult recipients can safely be performed without compromising graft outcome. METHODS From 2013 to 2017, a total of 102 SKTs in adult recipients were performed in our center using pediatric donors aged <12 years. We compared the outcomes from donors aged 8 to 36 months (the small-kidney group [SKG], n = 46) and from donors aged 3 to 12 years (the big-kidney group [BKG], n = 56). The median follow-up time was 30 months in the SKG and 28 months in the BKG. RESULTS All patients achieved satisfactory renal function after transplantation, despite the fact that some patients (SKG, 19.6%; BKG, 28.6%) developed delayed graft function. One-year graft survival and death-censored graft survival in the SKG were 89.1% and 100%, respectively, comparable to the results in the BKG (92.9% and 98.2%). One year later, the graft and patient survival rates in both groups remained unchanged. Pulmonary infection was the main cause of death in patients with a functioning graft (SKG, 4 patients; BKG, 2 patients). Proteinuria occurred early in some patients (SKG, 30.4%; BKG, 19.6%) and decreased gradually within the first year posttransplantation. CONCLUSIONS SKT from pediatric donors aged 8 to 36 months to selected adult recipients produced excellent intermediate-term outcomes, comparable with those when older pediatric donors were used. This study provides evidence to support a lower age limit for SKT from pediatric donors.
Collapse
|
17
|
Small Split Pediatric Kidneys to Expand the Donor Pool: An Analysis of Scientific Registry of Transplant Recipients (SRTR) Data. Transplantation 2020; 103:2549-2557. [PMID: 30893290 DOI: 10.1097/tp.0000000000002706] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Increased use of pediatric deceased donor kidneys could enlarge the deceased donor kidney pool. Kidney transplant outcomes from small pediatric donors were compared with those from ideal kidney (IK) and expanded criteria kidney (ECK) donors to understand the optimal use of pediatric donor kidneys. METHODS Kaplan-Meier analyses compared long-term patient and death-censored graft survival of en bloc kidney (EBK) and split kidney (SpK) transplants from small pediatric donors (aged ≤8 y and weight <30 kg) with those from IK and ECK. Posttransplant serum creatinine) was compared among these cohorts. Deceased donor kidney disposition was determined from small pediatric donors with ≥1 organ transplanted. RESULTS Patient and death-censored graft survival were similar among recipients of IK, EBK, and SpK transplants, and were superior to those of recipients of ECK. EBK and SpK transplants from donors 5-30 kg had first-year graft loss similar to ECK. Long-term graft survival and serum creatinine with kidneys from SpK donors >10 kg were better than that with ECK donors. About 3901 transplants were performed from 3660 pediatric donors (53% yield). CONCLUSIONS Pediatric kidneys can augment the kidney donor pool and should not be considered ECK. If 90% of kidneys from donors (aged ≤8 y and weight <30 kg) with ≥1 organ transplanted been used (as SpK when >10 kg) an additional 159 kidney transplants per year could have been performed. Expanding the use of pediatric kidneys should be further explored by the transplant community.
Collapse
|
18
|
Lo‐Cao E, Yao J, Robertson P, Clayton P, Cavazzoni E, Pleass H. Paediatric en bloc kidney transplantation from a donor less than 5 kg. ANZ J Surg 2019; 90:1793-1794. [DOI: 10.1111/ans.15642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 12/17/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Edward Lo‐Cao
- Department of Surgery Westmead Hospital Sydney New South Wales Australia
- Sydney Medical School The University of Sydney Sydney New South Wales Australia
| | - Jinna Yao
- Department of Surgery Westmead Hospital Sydney New South Wales Australia
- Sydney Medical School The University of Sydney Sydney New South Wales Australia
| | - Paul Robertson
- Department of Surgery Westmead Hospital Sydney New South Wales Australia
| | - Philip Clayton
- Department of Nephrology Royal Adelaide Hospital Adelaide South Australia Australia
| | - Elena Cavazzoni
- Department of Paediatrics and Child Health The Children's Hospital at Westmead Sydney New South Wales Australia
- DonateLife New South Wales NSW Organ and Tissue Donation Service Sydney New South Wales Australia
| | - Henry Pleass
- Department of Surgery Westmead Hospital Sydney New South Wales Australia
- Sydney Medical School The University of Sydney Sydney New South Wales Australia
| |
Collapse
|
19
|
Jin X, Hu JM, Liu YG, Zhao M. A Multicenter Clinical Study of Single-Kidney Transplantation vs En Bloc Transplantation with Kidneys from Deceased Pediatric Donors. Transplant Proc 2019; 51:3252-3258. [PMID: 31732202 DOI: 10.1016/j.transproceed.2019.06.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 05/08/2019] [Accepted: 06/05/2019] [Indexed: 01/02/2023]
Abstract
BACKGROUND There are still disputes regarding the choice of surgical approach to harvest organs from pediatric donors for organ recipients. The primary goal of this multicenter, retrospective analysis was to compare outcomes between single-kidney transplantation (SKT) and en bloc kidney transplantation (EBKT). METHODS Data from donors and recipients aged 4 to 18 months from 3 transplant centers over 5 year were collected to compare postoperative complications and recoveries of renal function between SKT and EBKT and to determine whether there is a difference in the 1-year patient and kidney survival rate between the 2 groups. RESULTS Between the SKT and EBKT groups, the incidence of delayed graft function was significantly higher in the SKT group than in the EBKT group (44.1% vs 17.3%, P = .03), and there were no significant differences in other complications (47.0% vs 59.0%, P = .36). Moreover, no significant differences were observed for the overall patient survival rate (P = .08) or the overall graft survival rate (P = .71). CONCLUSIONS The short-term effects of SKT make it worthy of consideration. For infants aged 4 to 18 months, SKT can provide good results, alleviating the current tense situation in kidney donation.
Collapse
Affiliation(s)
- Xiao Jin
- DongGuan People's Hospital, Dongguan, China; Guangzhou Key Laboratory of Inflammatory and Immune Diseases, Organ Transplantation Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Jian Min Hu
- Guangzhou Key Laboratory of Inflammatory and Immune Diseases, Organ Transplantation Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Yong Guang Liu
- Guangzhou Key Laboratory of Inflammatory and Immune Diseases, Organ Transplantation Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Ming Zhao
- Guangzhou Key Laboratory of Inflammatory and Immune Diseases, Organ Transplantation Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China.
| |
Collapse
|
20
|
Naik AS, Zhong Y, Parasuraman R, Doshi M, Norman S, Lu Y, Shaban E, Shahinian V, Schaubel DE. The temporal and long-term impact of donor body mass index on recipient outcomes after kidney transplantation - a retrospective study. Transpl Int 2019; 33:59-67. [PMID: 31478267 DOI: 10.1111/tri.13505] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 12/19/2018] [Accepted: 08/25/2019] [Indexed: 11/30/2022]
Abstract
The impact of increasing body mass index (BMI) on development and progression of chronic kidney disease is established. Even implantation kidney biopsies from obese living donors demonstrate subtle histologic changes despite normal function. We hypothesized that kidneys from obese living (LD) and deceased donors (DD) would have inferior long-term allograft outcomes. In a study utilizing US transplant registry, we studied adult kidney transplant recipients from 2000 to 2014. Donors were categorized as BMI <20 (underweight), 20-25 (normal), 25-30 (overweight), 30-35 (mildly obese), and >35 kg/m2 (very obese). Our outcome of interest was death censored graft failure (DCGF). Cox proportional hazards model were fitted separately for recipients of DD and LD kidneys, and adjusted for donor, recipient, and transplant characteristics, including donor and recipient size mismatch ratio. Among 118 734 DD and 84 377 LD transplants recipients, we observed a significant and graded increase in DCGF risk among the overweight (LD:HR = 1.06, DD:HR = 1.04), mildly obese (LD:HR = 1.16, DD:HR = 1.10), and very obese (LD:HR = 1.22, DD:HR = 1.22) compared to normal BMI (P < 0.05). The graded effect of donor BMI on outcomes begins early and persists throughout the post-transplant period. Donor obesity status is an independent risk factor for inferior long-term renal allograft outcome despite adjusting for donor and recipient size mismatch and other donor, recipient, and transplant factors.
Collapse
Affiliation(s)
- Abhijit S Naik
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Yingchao Zhong
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
| | - Ravi Parasuraman
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Mona Doshi
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Silas Norman
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Yee Lu
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Eman Shaban
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Vahakn Shahinian
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | | |
Collapse
|
21
|
Singh S, Pandey G, Sharma A, Kenwar D, Seth A. En-bloc kidney transplant from an 11-month-old pediatric donor to an adult recipient: Case report and review of literature. INDIAN JOURNAL OF TRANSPLANTATION 2019. [DOI: 10.4103/ijot.ijot_34_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
22
|
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.
Collapse
|
23
|
|
24
|
Gander R, Asensio M, Molino JA, Royo GF, Ariceta G, Muñoz M, López M. Is donor age 6 years or less related to increased risk of surgical complications in pediatric kidney transplantation? J Pediatr Urol 2018; 14:442.e1-442.e8. [PMID: 29636297 DOI: 10.1016/j.jpurol.2018.03.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Accepted: 03/13/2018] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Despite the widespread organ shortage dilemma, there is hesitancy regarding utilization of young donors (aged ≤6 years) because previous reports have suggested that this is associated with an increased risk of surgical complications and graft loss. OBJECTIVE The aim of this study was to determine if donor age ≤6 years is related to increased risk of surgical complications or allograft loss in pediatric kidney transplantation (KT). STUDY DESIGN A retrospective study of pediatric kidney transplants (KT) undertaken between January 2000 and July 2015. The incidence of surgical and urological complications, and allograft loss were analyzed and compared between donors aged ≤6 years (Group 1) and donors aged >6 years (Group 2). RESULTS A total of 171 pediatric KTs were performed at the current center during the study period. Twenty-eight patients were excluded; as a result, the study comprised 143 patients: 60 (Group 1) and 83 (Group 2). Mean recipient weight was 17 kg (SD 9.7; range 3.2-47) in Group 1 and 38.2 kg (SD 15.3; range 7.8-73) in Group 2. Despite a significantly higher proportion of risk factors in Group 1, no significant between-group differences were observed in terms of: surgical complications (OR 0.4; range 0.1-1.2), early urological complications (OR 2.2; range 0.4-11), late urological complications (OR 0.3; range 0.8-1.4), lymphoceles (OR 6.2; range 0.7-51.7) and allograft loss (OR 1.5; range 0.7-3.1, summary Table). Graft survival at 1 and 5 years was: 81% and 70% (Group 1) and 92% and 79% (Group 2), respectively (P = 0.093). Mean follow-up was 90.13 ± 49.7 months. DISCUSSION The main finding of this retrospective study was that pediatric donor kidneys from donors aged ≤6 years could safely be used in pediatric recipients without an increased risk of surgical and urological complications or graft loss. Nevertheless, KT with small donor kidneys is challenging and should be performed at experienced pediatric centers. CONCLUSION In line with these results, the outcomes of KT using donors aged ≤6 years were encouraging and similar to those obtained with older donors. Thus, this study supported using kidney grafts from young donors, given the organ shortage and potential high mortality risk while awaiting KT.
Collapse
Affiliation(s)
- R Gander
- Department of Pediatric Surgery, Pediatric Urology and Renal Transplant Unit, University Hospital Vall d'Hebron, Barcelona, Spain.
| | - M Asensio
- Department of Pediatric Surgery, Pediatric Urology and Renal Transplant Unit, University Hospital Vall d'Hebron, Barcelona, Spain
| | - J A Molino
- Department of Pediatric Surgery, Pediatric Urology and Renal Transplant Unit, University Hospital Vall d'Hebron, Barcelona, Spain
| | - G F Royo
- Department of Pediatric Surgery, Pediatric Urology and Renal Transplant Unit, University Hospital Vall d'Hebron, Barcelona, Spain
| | - G Ariceta
- Department of Pediatric Nephrology, University Hospital Vall d'Hebron, Barcelona, Spain; Department of Pediatrics, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - M Muñoz
- Department of Pediatric Nephrology, University Hospital Vall d'Hebron, Barcelona, Spain
| | - M López
- Department of Pediatric Surgery, University Hospital Vall d'Hebron, Barcelona, Spain
| |
Collapse
|
25
|
Martinez-Lopez S, Wijetunga I, Ecuyer C, Ahmad N. Bilateral adrenal hemorrhage in a neonatal kidney donor. Pediatr Transplant 2018; 22:e13173. [PMID: 29624811 DOI: 10.1111/petr.13173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/29/2018] [Indexed: 11/27/2022]
Abstract
EKT from neonatal donors remains rare despite successful outcome being reported. The surgical aspects of neonatal abdominal organ recovery remain unfamiliar to the vast majority of abdominal organ recovery teams and renal transplant surgeons. BAH is not uncommon in newborn babies suffering distress in the perinatal period. BAH is often also associated with RVT and will impact on utilization of kidneys for transplantation. We present a case of a neonatal kidney donor with massive BAHs discovered at the time of organ recovery. This made the procurement challenging. Both kidneys were recovered en bloc with pancreas and the liver with aorta and inferior vena cave as vascular conduits. The kidneys were successfully implanted into an adult recipient with good function at 1-year follow-up. Association between adrenal hemorrhage and RVT needs to be considered before utilizing such kidneys. This case exemplifies successful outcome after careful assessment and transplantation of such kidneys.
Collapse
Affiliation(s)
| | - Imeshi Wijetunga
- Department of Transplantation, St James's University Hospital, Leeds, UK
| | - Clare Ecuyer
- Department of Transplantation, St James's University Hospital, Leeds, UK
| | - Niaz Ahmad
- Department of Transplantation, St James's University Hospital, Leeds, UK
| |
Collapse
|
26
|
Chesnaye NC, van Stralen KJ, Bonthuis M, Groothoff JW, Harambat J, Schaefer F, Canpolat N, Garnier A, Heaf J, de Jong H, Schwartz Sørensen S, Tönshoff B, Jager KJ. The association of donor and recipient age with graft survival in paediatric renal transplant recipients in a European Society for Paediatric Nephrology/European Renal Association-European Dialysis and Transplantation Association Registry study. Nephrol Dial Transplant 2018; 32:1949-1956. [PMID: 28992338 DOI: 10.1093/ndt/gfx261] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 07/12/2017] [Indexed: 12/12/2022] Open
Abstract
Background The impact of donor age in paediatric kidney transplantation is unclear. We therefore examined the association of donor-recipient age combinations with graft survival in children. Methods Data for 4686 first kidney transplantations performed in 13 countries in 1990-2013 were extracted from the ESPN/ERA-EDTA Registry. The effect of donor and recipient age combinations on 5-year graft-failure risk, stratified by donor source, was estimated using Kaplan-Meier survival curves and Cox regression, while adjusting for sex, primary renal diseases with a high risk of recurrence, pre-emptive transplantation, year of transplantation and country. Results The risk of graft failure in older living donors (50-75 years old) was similar to that of younger living donors {adjusted hazard ratio [aHR] 0.74 [95% confidence interval (CI) 0.38-1.47]}. Deceased donor (DD) age was non-linearly associated with graft survival, with the highest risk of graft failure found in the youngest donor age group [0-5 years; compared with donor ages 12-19 years; aHR 1.69 (95% CI 1.26-2.26)], especially among the youngest recipients (0-11 years). DD age had little effect on graft failure in recipients' ages 12-19 years. Conclusions Our results suggest that donations from older living donors provide excellent graft outcomes in all paediatric recipients. For young recipients, the allocation of DDs over the age of 5 years should be prioritized.
Collapse
Affiliation(s)
- Nicholas C Chesnaye
- Department of Medical Informatics, ESPN/ERA-EDTA Registry and ERA-EDTA Registry, Amsterdam, The Netherlands
| | | | - Marjolein Bonthuis
- Department of Medical Informatics, ESPN/ERA-EDTA Registry and ERA-EDTA Registry, Amsterdam, The Netherlands
| | - Jaap W Groothoff
- Department of Pediatric Nephrology, Emma Children's Hospital AMC, Amsterdam, The Netherlands
| | - Jérôme Harambat
- Department of Pediatrics, Bordeaux University Hospital, Bordeaux, France
| | - Franz Schaefer
- Division of Paediatric Nephrology, University of Heidelberg, Center for Pediatrics and Adolescent Medicine, Heidelberg, Germany
| | - Nur Canpolat
- Department of Pediatrics, Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Arnaud Garnier
- Pediatric Nephrology Unit, Toulouse University Hospital, Toulouse, France
| | - James Heaf
- Department of Medicine, Zealand University Hospital, Roskilde, Denmark
| | - Huib de Jong
- Erasmus Medical Center, Rotterdam, The Netherlands
| | - Søren Schwartz Sørensen
- Department of Nephrology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Burkhard Tönshoff
- Department of Pediatrics I, University Children's Hospital, Heidelberg, Germany
| | - Kitty J Jager
- Department of Medical Informatics, ESPN/ERA-EDTA Registry and ERA-EDTA Registry, Amsterdam, The Netherlands
| |
Collapse
|
27
|
Long-term Outcomes of Pediatric En Bloc Compared to Living Donor Kidney Transplantation. Transplantation 2018; 102:e245-e248. [DOI: 10.1097/tp.0000000000002104] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
28
|
Fayek SA, Ali MS, Hasham L, Herbert M, Allam SR, Rofaiel G. Expanding the Envelope: Favorable Outcomes Utilizing Kidneys From Small Pediatric Donors (≤ 15 kg). Transplant Proc 2018; 50:3204-3210. [PMID: 30577186 DOI: 10.1016/j.transproceed.2018.04.037] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 03/23/2018] [Accepted: 04/12/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Utilization of kidneys from small pediatric donors (SPDs ≤ 15 kg) is limited. Decisions to split and use the kidneys for 2 recipients remain controversial. METHODS Retrospective single-center study aimed primarily at evaluating graft loss within 30 days after transplant using SPD kidneys. Recipients were divided into group A (donor weight < 10 kg, n = 24) and group B (≥ 10 kg, n = 16). RESULTS Forty transplants were performed with 100% patient survival. Mean follow-up was 402 days, overall graft survival was 95%, with 91.7% and 100% in groups A and B, respectively (P = .24). Mean recipient-to-donor weight ratio (RTDWR) was higher in group A (10.5 vs 6.3, P < .001). Surgical complications were similar between the groups. These were more common with en bloc compared to single implantation (P = .05), and RTDWR was the main predictor (P = .005). Graft function was similar between the groups; mean 12-month creatinine was 1.2 mg % and eGFR was 58.2 mL/min/1.73 m2. Sixteen out of 38 patients developed proteinuria (42%) with no difference among subgroups, although male recipients were at a higher risk (OR = 8.4 [95% CI 1.5-46.1], P = .014); 83% responded to therapy. CONCLUSION Utilization and early splitting of SPD kidneys yields favorable graft survival and function irrespective of donor weight and age. Early splitting should be considered.
Collapse
Affiliation(s)
- S A Fayek
- Department of Transplantation, Medical City Fort Worth Transplant Institute, Fort Worth, TX; Kasr Al Ainy, Department of General Surgery, Faculty of Medicine, General Surgery, Cairo University, Cairo, Egypt.
| | - M S Ali
- Department of Transplantation, Medical City Fort Worth Transplant Institute, Fort Worth, TX
| | - L Hasham
- Department of Transplantation, Medical City Fort Worth Transplant Institute, Fort Worth, TX
| | - M Herbert
- Department of Clinical Research, Medical City Dallas Hospital, Dallas, TX
| | - S R Allam
- Department of Transplantation, Medical City Fort Worth Transplant Institute, Fort Worth, TX
| | - G Rofaiel
- Division of Transplantation and Advanced Hepatobiliary Surgery, University of Utah, Salt Lake City, UT
| |
Collapse
|
29
|
Asgari MA, Besharat S, Bakhtiyari M, Alirezaei A. Successful Repair of Bilateral Ureteral Stricture 3 Years after En Bloc Kidney Transplant: A Case Report. EXP CLIN TRANSPLANT 2018; 17:819-822. [PMID: 29633933 DOI: 10.6002/ect.2017.0228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
En bloc kidney transplants of small pediatric kidneys into adult recipients have been shown to have outcomes similar to transplants from standard adult deceased donors. Here, we report a 27-year-old male patient with successful repair of bilateral ureteral stricture 3 years after en bloc kidney transplant at the Shahid Modarres Hospital (Tehran, Iran). The patient received an en bloc deceased kidney donation from a 9-month-old infant. An end-to-end anastomosis of the aorta to the internal iliac artery and an end-to-side external iliac vein anastomosis to vena cava were performed. At an outpatient visit about 2.5 years later, the patient showed increasing levels of creatinine from 1.1 to 1.8 mg/dL compared with measurements at his 2-month visit. A computed tomography scan performed without any contrast agent at that time confirmed the existence of hydronephrosis in both the medial and lateral kidneys. A nephrostography showed a ureteral stricture. Because endoscopic surgery for ureteral dilatation was not successful, the decision was made to perform ureteral repair by the open surgical technique. The short length of the ureters resulted in the lateral renal pelvis being anastomosed to the bladder by flap (Boari flap). The ureter of the patient's native kidney was transected in the middle portion, and the distal ureter was anastomosed to the medial renal pelvis using the end-to-end method. Here, we showed that, despite limited experiences with pediatric donors, en bloc kidney transplant can be performed under the guidance of experienced surgical techniques and precise postoperative follow-up.
Collapse
Affiliation(s)
- Majid Ali Asgari
- From the Urology and Nephrology Research Center, Shahid Modarress Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | | | | |
Collapse
|
30
|
Yaffe HC, Friedmann P, Kayler LK. Very small pediatric donor kidney transplantation in pediatric recipients. Pediatr Transplant 2017; 21. [PMID: 28397368 DOI: 10.1111/petr.12924] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/24/2017] [Indexed: 11/30/2022]
Abstract
Kidneys from very small pediatric donors (age <5 years, weight <21 kg) may be a means to increase the donor pool for pediatric recipients. Transplantation of small pediatric kidneys is more commonly performed in adult recipients due to the increased risks of technical complications, thrombosis, and early graft failure. While these risks are abrogated in adult recipients by limiting the donor weight to ≥10 kg and using the EB technique, it is unknown whether pediatric recipients achieve comparable results. US national data were assessed for all first-time, deceased-donor, kidney-only pediatric recipients, 1/1996-10/2013, who received very small pediatric donor grafts or grafts from ideal adult donors. We identified 57 pediatric EB, 110 pediatric SK, and 2350 adult transplants. The primary outcome was 3-year all-cause graft survival. Kaplan-Meier curves showed worse outcomes for pediatric grafts compared to adult ideal grafts (P=.042). On multivariate analysis, pediatric recipients of SK grafts had significantly higher HRs (aHR 2.01, 95% CI 1.34-3.00) and pediatric recipients of EB grafts had somewhat higher non-significant HRs (1.57; 95% CI 0.88-2.79) for graft survival. These results suggest cautionary use of very small pediatric donors as a source to expand the donor pool for pediatric candidates.
Collapse
Affiliation(s)
- H C Yaffe
- Department of Surgery, Albert Einstein College of Medicine, Bronx, NY, USA.,Department of Surgery, Montefiore Medical Center, Bronx, NY, USA
| | - P Friedmann
- Department of Surgery, Albert Einstein College of Medicine, Bronx, NY, USA
| | - L K Kayler
- Department of Surgery, Erie County Medical Center, Buffalo, NY, USA
| |
Collapse
|
31
|
Milonas D, Skarupskiene I, Aniulis P, Stramaityte I, Dalinkeviciene E, Stankuviene A. En bloc kidney transplantation from a 24 month-old donor to an adult recipient: case presentation and literature review. Cent European J Urol 2017; 70:123-127. [PMID: 28462001 PMCID: PMC5407329 DOI: 10.5173/ceju.2016.911] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 10/07/2016] [Accepted: 10/19/2016] [Indexed: 11/22/2022] Open
Abstract
Paediatric kidney transplantation into adult recipients is a well-recognised technique. However, there are different opinions regarding two methods of transplantation. These two opinions are single kidney transplantation (SKT) and en bloc kidney transplantation (EBKT) from donors up to 20 kg. We are reporting the first successful en bloc kidney transplantation from a small, paediatric donor into an adult recipient in our institution and discussing the appropriate recent literature regarding possible concerns using this technique. Despite the fact that paediatric donors are uncommon and surgical experiences are limited, en bloc kidney transplantation can be performed successfully and could be used to expand the donor pool.
Collapse
|
32
|
Wang HY, Li J, Liu LS, Deng RH, Fu Q, Ko DSC, Zhang HX, Deng SX, Wang CX. En bloc kidney transplantation from infant donors younger than 10 months into pediatric recipients. Pediatr Transplant 2017; 21. [PMID: 28042690 DOI: 10.1111/petr.12845] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/19/2016] [Indexed: 11/29/2022]
Abstract
Early graft loss and poor graft function limit the use of kidneys from infant donors. Six en bloc kidney transplantations were performed from infant donors younger than 10 months into pediatric recipients between November 2012 and September 2015 at our center. We retrospectively analyzed recipient and donor demographics, surgery procedures, complications, graft function and size, and patient and graft survival with a follow-up of 6-39 months (median 15.5 months). Donor age ranged from 1 to 10 months with weight ranging from 3.5 to 10 kg. Recipient age ranged from 10 to 16 years with weight ranging from 30 to 39 kg. One kidney was removed due to arterial thrombosis during surgery, while the other kidney of this en bloc graft remained viable. Urine leak followed by bilateral ureteral obstruction occurred in one recipient. All of the recipients showed immediate graft function. The size of the en bloc kidney increased from 4.2±0.6 cm to 7.6±0.6 cm 6 months after surgery. Patient and graft survival were both 100% at the last follow-up. Our results show that en bloc kidney transplantation from infant donors younger than 10 months into pediatric recipients is effective under the condition of experienced surgical techniques and perioperative management.
Collapse
Affiliation(s)
- Hong-Yang Wang
- Organ Transplantation Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jun Li
- Organ Transplantation Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Long-Shan Liu
- Organ Transplantation Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Rong-Hai Deng
- Organ Transplantation Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Qian Fu
- Organ Transplantation Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Dicken Shiu-Chung Ko
- Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Huan-Xi Zhang
- Organ Transplantation Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Su-Xiong Deng
- Organ Transplantation Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Chang-Xi Wang
- Organ Transplantation Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory on Organ Donation and Transplant Immunology, Guangzhou, China
| |
Collapse
|
33
|
En Bloc Cadaver Kidney Transplantation From a 9-Month-Old Donor to an Adult Recipient: Maturation of Glomerular Size and Podocyte in the Recipient. Transplant Direct 2017; 3:e130. [PMID: 28361114 PMCID: PMC5367747 DOI: 10.1097/txd.0000000000000648] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 12/19/2016] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Favorable outcomes of en bloc pediatric donor kidney transplantation to adult recipients are attributed primarily to grafting of twice the nephron mass of a single kidney. METHODS The kidneys of a 9-month-old male infant were transplanted en bloc in a 56-year-old man. Biopsies were performed 1 hour postreperfusion, 6 months and 3.5 years posttransplant. RESULTS Warm and cold ischemia times were 21 and 426 minutes, respectively. The recipient was released from hemodialysis 10 days posttransplant and discharged 91 days posttransplant when serum creatinine was 0.9 mg/dL. At 4 years and 9 months posttransplant, serum creatinine was 1.0 mg/dL, and estimated glomerular filtration rate was 58.0 mL/min per 1.73 m2. The grafts increased in size until they reached adult size by 3 months posttransplant. The glomerular area and volume, respectively, increased from 5.9 × 103 μm2 and 0.34 × 106 μm3 at 1 hour postreperfusion to 14.9 × 103 μm2 and 1.27 × 106 μm3 at 3.5 years posttransplant, both of which were less than half of adult size. At 1 hour postreperfusion, podocytes were structurally immature. At 6 months posttransplant, podocyte immaturity was still evident. At 3.5 years posttransplant, podocytes were mature. CONCLUSIONS These findings suggest that podocytes and glomerular size of pediatric donor kidneys can continue to mature in adult recipients at rates appropriate for donor age when transplanted en bloc. The maturational levels of podocytes and glomeruli may also be a factor involved in favorable outcomes of en bloc pediatric donor kidney transplantation.
Collapse
|
34
|
Surgical Complications in En Bloc Renal Transplantation. Transplant Proc 2016; 48:2953-2955. [DOI: 10.1016/j.transproceed.2016.09.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 08/20/2016] [Accepted: 09/02/2016] [Indexed: 11/18/2022]
|
35
|
Fananapazir G, Tse G, Corwin MT, Santhanakrishnan C, Perez RV, McGahan JP, Stewart S, Troppmann C. Pediatric En Bloc Kidney Transplants: Clinical and Immediate Postoperative US Factors Associated with Vascular Thrombosis. Radiology 2016; 279:935-42. [DOI: 10.1148/radiol.2015150430] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
36
|
Al-Shraideh Y, Farooq U, El-Hennawy H, Farney AC, Palanisamy A, Rogers J, Orlando G, Khan M, Reeves-Daniel A, Doares W, Kaczmorski S, Gautreaux MD, Iskandar SS, Hairston G, Brim E, Mangus M, Stratta RJ. Single vs dual ( en bloc) kidney transplants from donors ≤ 5 years of age: A single center experience. World J Transplant 2016; 6:239-248. [PMID: 27011923 PMCID: PMC4801801 DOI: 10.5500/wjt.v6.i1.239] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Revised: 10/02/2015] [Accepted: 12/02/2015] [Indexed: 02/05/2023] Open
Abstract
AIM: To compare outcomes between single and dual en bloc (EB) kidney transplants (KT) from small pediatric donors.
METHODS: Monocentric nonprospective review of KTs from pediatric donors ≤ 5 years of age. Dual EB KT was defined as keeping both donor kidneys attached to the inferior vena cava and aorta, which were then used as venous and arterial conduits for the subsequent transplant into a single recipient. Donor age was less useful than either donor weight or kidney size in decision-making for kidney utilization as kidneys from donors < 8 kg or kidneys < 6 cm in length were not transplanted. Post-transplant management strategies were standardized in all patients.
RESULTS: From 2002-2015, 59 KTs were performed including 34 dual EB and 25 single KTs. Mean age of donors (17 mo vs 38 mo, P < 0.001), mean weight (11.0 kg vs 17.4 kg, P = 0.046) and male donors (50% vs 84%, P = 0.01) were lower in the dual EB compared to the single KT group, respectively. Mean cold ischemia time (21 h), kidney donor profile index (KDPI; 73% vs 62%) and levels of serum creatinine (SCr, 0.37 mg/dL vs 0.49 mg/dL, all P = NS) were comparable in the dual EB and single KT groups, respectively. Actuarial graft and patient survival rates at 5-years follow-up were comparable. There was one case of thrombosis resulting in graft loss in each group. Delayed graft function incidence (12% dual EB vs 20% single KT, P = NS) was slightly lower in dual EB KT recipients. Initial duration of hospital stay (mean 5.4 d vs 5.6 d) and the one-year incidences of acute rejection (6% vs 16%), operative complications (3% vs 4%), and major infection were comparable in the dual EB and single KT groups, respectively (all P = NS). Mean 12 mo SCr and abbreviated MDRD levels were 1.17 mg/dL vs 1.35 mg/dL and 72.5 mL/min per 1.73 m2vs 60.5 mL/min per 1.73 m2 (both P = NS) in the dual EB and single KT groups, respectively.
CONCLUSION: By transplanting kidneys from young pediatric donors into adult recipients, one can effectively expand the limited donor pool and achieve excellent medium-term outcomes.
Collapse
|
37
|
Chinese Pediatric Organ Donation With Scheduled Cardiac Arrest After Brain Death: A Novel China Classification Beyond Maastricht. Transplant Proc 2015; 47:2836-40. [PMID: 26707298 DOI: 10.1016/j.transproceed.2015.10.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 10/07/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Organ donation with scheduled cardiac arrest after brain death (s-DBCD) is a special category in China. This study was to evaluate the procedure of pediatric s-DBCD, graft quality, and clinical outcomes of single kidney transplantation. METHODS We retrospectively analyzed the data of 8 Chinese pediatric donors. RESULTS The death causes of the donors (age 4-12 years) were cerebral hypoxia after cardiopulmonary resuscitation (n = 1), intracranial vascular malformation (n = 1), severe traumatic brain injury (n = 3), and brain malignancy (n = 3). The functional warm ischemia time of the grafts was 18 (13-26) minutes. Sixteen kidneys were recovered using liver-kidney en bloc procurement after in situ perfusion. All kidneys had a length >7 cm and were transplanted to 3 adolescent and 13 adult recipients. Two cases of delayed graft function occurred. The patients had a median serum creatinine level of 97 (55-123) μmol/L by the last visit. The median estimated glomerular filtration rate level was 85.4 (58-136) mL/min. Five episodes of biopsy-proven acute rejection occurred in 4 patients, which were reversed by methylprednisolone pulse therapy. Renal arterial stenosis was observed in 1 patient, which was cured by interventional balloon dilatation and stent implantation. CONCLUSION Pediatric s-DBCD is feasible with acceptable graft quality. Single kidney transplantation with pediatric graft size >7 cm has good clinical outcomes.
Collapse
|
38
|
Song SH, Lee J, Han WK, Kim YS, Huh KH. Adult Kidney Transplantation of Pediatric En bloc Kidneys Using a Partial Bladder Wall. KOREAN JOURNAL OF TRANSPLANTATION 2015. [DOI: 10.4285/jkstn.2015.29.3.170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Seung Hwan Song
- Department of Transplantation Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Juhan Lee
- Department of Transplantation Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Woong Kyu Han
- Department of Urology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yu Seun Kim
- Department of Transplantation Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Kyu Ha Huh
- Department of Transplantation Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| |
Collapse
|
39
|
Wang Z, Yap HK, Prabhakaran K, Tiong HY. Optimising utilisation of kidneys from very young deceased donors: the technique of en bloc kidney transplantation. Singapore Med J 2015; 56:e137-8. [PMID: 26310490 DOI: 10.11622/smedj.2015128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Kidneys of paediatric deceased donors were previously considered suboptimal for older recipients. An 18-month-old deceased donor was made available via Singapore's Medical (Therapy, Education and Research) Act. To the best of our knowledge, she is the youngest local donor. We herein report a case of successful kidney transplantation, using the en bloc technique, to a 15-year-old girl with renal failure secondary to bilateral cystic dysplastic kidney.
Collapse
Affiliation(s)
- Ziting Wang
- Department of Urology, National University Health System, Singapore
| | - Hui Kim Yap
- Department of Paediatrics Renal Medicine, National University Health System, Singapore
| | | | - Ho Yee Tiong
- Department of Urology, National University Health System, Singapore
| |
Collapse
|
40
|
Single kidneys transplanted from small pediatric donors less than 15 kilograms into pediatric recipients. Transplantation 2015; 98:e97-100. [PMID: 25955345 DOI: 10.1097/tp.0000000000000529] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
|
41
|
Dion M, Rowe N, Shum J, Weernink C, Felbel S, McAlister VC, Sener A, Luke PP. Donation after Cardiac Death Pediatric En Bloc Renal Transplantation. J Urol 2015; 193:281-5. [DOI: 10.1016/j.juro.2014.07.089] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2014] [Indexed: 11/25/2022]
Affiliation(s)
- Marie Dion
- Department of Surgery, Division of Urology, Western University, London, Ontario, Canada
| | - Neal Rowe
- Department of Surgery, Division of Urology, Western University, London, Ontario, Canada
- Multi-Organ Transplant Program, London Health Sciences Center, London, Ontario, Canada
| | - Jeffrey Shum
- Department of General Surgery, Western University, London, Ontario, Canada
- Multi-Organ Transplant Program, London Health Sciences Center, London, Ontario, Canada
| | - Corinne Weernink
- Multi-Organ Transplant Program, London Health Sciences Center, London, Ontario, Canada
| | - Sarah Felbel
- Department of Surgery, Division of Urology, Western University, London, Ontario, Canada
- Multi-Organ Transplant Program, London Health Sciences Center, London, Ontario, Canada
| | - Vivian C. McAlister
- Department of General Surgery, Western University, London, Ontario, Canada
- Multi-Organ Transplant Program, London Health Sciences Center, London, Ontario, Canada
| | - Alp Sener
- Department of Surgery, Division of Urology, Western University, London, Ontario, Canada
- Multi-Organ Transplant Program, London Health Sciences Center, London, Ontario, Canada
| | - Patrick P. Luke
- Department of Surgery, Division of Urology, Western University, London, Ontario, Canada
- Multi-Organ Transplant Program, London Health Sciences Center, London, Ontario, Canada
| |
Collapse
|
42
|
Li Y, Li J, Fu Q, Deng R, Liu L, Yuan X, Wang C. En Bloc Dual Kidney Transplantation from Pediatric Donors after Cardiac Death: Initial Experience in China. Urol Int 2014; 93:482-6. [DOI: 10.1159/000365579] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Accepted: 06/29/2014] [Indexed: 11/19/2022]
|
43
|
Cesca E, Ghirardo G, Kiblawi R, Murer L, Gamba P, Zanon GF. Delayed graft function in pediatric deceased donor kidney transplantation: donor-related risk factors and impact on two-yr graft function and survival: a single-center analysis. Pediatr Transplant 2014; 18:357-62. [PMID: 24712721 DOI: 10.1111/petr.12252] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/21/2014] [Indexed: 11/30/2022]
Abstract
There is mounting evidence that the quality of organs from cadaver donors may be influenced by events occurring around the time of brain death. Aim of this present study was to analyze the correlation of DGF with brain-dead donor variables in a single-center pediatric population and to evaluate DGF influence on patients- and grafts outcome. End-points of the study were DGF prevalence, DGF donor-related risk factors, graft function, patient- and graft survival rate, respectively, at six, 12, and 24 months FU. The univariate analysis showed that donor age above 15 yr and vascular cause of donor brain death represented risk factors for DGF. The multivariate analysis confirmed as independent risk factors for DGF donor age >15 yr. At six months FU, DGF showed a negative impact on graft function. In conclusion, among all considered brain-dead donor resuscitation parameters, just non-traumatic cause of death turned out to be of impact for DGF. Donor age >15 yr represented the only independent risk factor for prolonged DGF in our series of children. At two-yr FU, DGF showed a transient negative impact on six-month graft function.
Collapse
|
44
|
Feltran LDS, Nogueira PCK, Ajzen SA, Verrastro CGY, Pacheco-Silva A. Does graft mass impact on pediatric kidney transplant outcomes? Pediatr Nephrol 2014; 29:297-304. [PMID: 24122259 DOI: 10.1007/s00467-013-2637-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2013] [Revised: 09/05/2013] [Accepted: 09/09/2013] [Indexed: 11/27/2022]
Abstract
BACKGROUND The aim of this study is to assess the evolution of renal size and function in pediatric transplant patients according to the graft mass/recipient size ratio. METHODS Fifty pediatric renal transplant recipients were followed over 2 years. Grafts were weighed, and three different graft mass/m(2) ratios were determined: (1) low graft mass (58 g/m(2), range 31-57 g/m(2)), (2) median (142 g/m(2), range 59-141 g/m(2)) and high (267 g/m(2), range 143-353 g/m(2)). Patients underwent repeated ultrasound Doppler scans and repeated measurements of estimated glomerular filtration rate (eGFR; 1 week and 1, 6, 12 and 24 months), urinary retinol-binding protein (RBP) and proteinuria (1 week and 6, 12 and 24 months). RESULTS The volume of renal tissue increased by 12 ± 5.6 cm(3) at 24 months (p = 0.035) in the low graft mass and decreased by -14 ± 7 cm(3) (p = 0.046) in the high graft mass. The eGFR increased when either low (30 ± 5 ml/min/1.73 m(2), p < 0.001) or median (19 ± 4 ml/min/1.73 m(2), p < 0.001) graft mass was transplanted but remained stable when high graft mass was transplanted. The resistive index (RI) presented a significant decrease throughout early follow-up in the transplants involving low and median graft mass, whereas a slight rise was observed in those involving high graft mass. A significant difference was apparent 6 months post-transplant. Transplants of low and median graft mass were associated with an initial higher urinary RBP. No significant differences in proteinuria were detected. CONCLUSIONS Small kidneys undergo increases in volume and function without escalation of either proteinuria or urinary RBP, characterizing an adequate adaptation to the recipient. Children receiving larger kidneys present a reduction in volume, stable GFR and higher RI at 6 months.
Collapse
|
45
|
Friedersdorff F, Fuller TF, Werthemann P, Cash H. Outcome of single pediatric deceased donor renal transplantation to adult kidney transplant recipients. Urol Int 2013; 92:323-7. [PMID: 24281008 DOI: 10.1159/000354277] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Accepted: 07/04/2013] [Indexed: 11/19/2022]
Abstract
INTRODUCTION In times of organ shortage more kidneys were transplanted in 'expanded criteria kidney' programs. This study examines the outcome of adult kidney recipients from pediatric donors. MATERIALS AND METHODS This single-center retrospective analysis evaluated eight adult patients who received a kidney from a deceased pediatric donor (age 5-17) between 06/2000 and 09/2011. RESULTS The median donor age was 14 years (range 5-17). The median recipient age was 49 years (range 25-57). The median cold ischemia time was 13.3 h (range 4.3-20.1), while the median warm ischemia time was 53 min (range 42-60). The median follow-up was 35.8 months (range 7-142). Acute rejection was observed in 50.0% of cases. The median HLA mismatch was 2.0. The median 1-year creatinine level was 0.95 mg/dl, the uncensored 1-year graft survival was 75.0% and the 3-year graft survival 62.5%, respectively. No recipient died within the follow-up period. As severe surgical complications, one stenosis of the renal artery and one lymphocele needing surgical revision were observed. CONCLUSIONS Renal transplantation of a deceased single pediatric donor to an adult recipient can be performed safely and shows a good outcome. Wherever feasible, single pediatric kidney transplantation can double the number of recipients over an 'en-bloc' transplantation. The price for a single pediatric kidney transplant may be a higher vascular complication rate and a higher rejection risk. Despite the higher risks, transplantation of a single pediatric donor kidney should be performed when accomplishable.
Collapse
Affiliation(s)
- Frank Friedersdorff
- Department of Urology, Charité - Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
| | | | | | | |
Collapse
|
46
|
Maluf DG, Carrico RJ, Rosendale JD, Perez RV, Feng S. Optimizing recovery, utilization and transplantation outcomes for kidneys from small, ≤20 kg, pediatric donors. Am J Transplant 2013; 13:2703-12. [PMID: 24010942 DOI: 10.1111/ajt.12410] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2012] [Revised: 05/31/2013] [Accepted: 06/23/2013] [Indexed: 01/25/2023]
Abstract
The optimal balance between maximizing the number versus the outcome of transplantation utilizing kidneys from small (≤20 kg) pediatric donors remains unclear, complicated by the choice of single versus en bloc transplantation with their attendant technical risks. Using the Organ Procurement and Transplantation Network (OPTN) database, we examined kidney recovery and utilization patterns, and 1-year transplant outcomes by single kilogram weight strata. Between January 1, 2005 and June 30, 2010, 2352 kidneys from ≤20 kg donors were transplanted into 1531 recipients, 710 single kidney transplants (SKTs) and 821 en bloc kidney transplants (EBKTs). Increased donor weight was associated with higher rates of recovery, transplantation and SKT. Low donor weight (linear p < 0.001; quadratic p = 0.003), SKT versus EBKT (p = 0.008), increased cold ischemia time (p = 0.003), local versus nonlocal donor (p = 0.0044), low versus high volume center (p = 0.003) and the interaction term between center volume and donor weight (p = 0.0024) were associated with graft failure. Notably, lower donor weight exacerbated the negative impact of low center volume but did not worsen the negative impact of SKT on outcomes. Our data show that EBKT offers superior 1-year survival at the expense of accomplishing one rather than two transplants. However, SKTs yield excellent outcomes when performed at experienced centers.
Collapse
Affiliation(s)
- D G Maluf
- Transplant Division, Department of Surgery, University of Virginia, Charlottesville, VA
| | | | | | | | | |
Collapse
|
47
|
Mwipatayi BP, Leong CW, Subramanian P, Picardo A. En bloc kidney transplant from an 18-month-old donor to an adult recipient: Case report and literature review. Int J Surg Case Rep 2013; 4:948-51. [PMID: 24055914 PMCID: PMC3825985 DOI: 10.1016/j.ijscr.2013.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2013] [Accepted: 08/15/2013] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION There is an ever-increasing need for organ donations globally. Paediatric kidney transplantation into adult recipients is a well-recognised technique to expand the donor pool. The transplantation can be done either via en bloc kidney transplant (EBKT) or as single kidney transplantation (SKT). PRESENTATION OF CASE An EKBT from a 18-month-old (15 kg) male patient was transplanted in a 35-year old, 85 kg male with end stage renal failure (ESRF), secondary to Focal Segmental Glomerulosclerosis (FSGS) on haemodialysis. Post-operative recovery was uneventful. Immuno-suppressant drugs used were tacrolimus, basiliximab and prednisolone. Doppler ultrasound scans performed post-operatively showed normal renal resistive indices in both kidneys. Serum creatinine decreased from 1200 to 170 μmol/L 57 with eGFR improving from 4 to 38 mL/min/1.73 m2 at four weeks post-transplant. DISCUSSION Given the low incidence of paediatric donors, EBKTs are relatively uncommon and subsequently published series tend to be centre specific with small numbers. The graft survival rates tell us that paediatric kidney donors should not be considered as marginal transplants. The difficulty is in determining when it is more appropriate to perform a paediatric EBKT as opposed to splitting and performing two SKT. Unfortunately there are no widely accepted guidelines to direct clinicians. CONCLUSION This case report highlights the first EKBT performed at our institution. The current literature demonstrates that paediatric donors are excellent resources that should be procured whenever available.
Collapse
Affiliation(s)
- B Patrice Mwipatayi
- University of Western Australia, School of Surgery, Crawley WA 6009, Australia; Department of Vascular Surgery, Royal Perth Hospital, Level 2, MRF Building, Perth, WA 6001, Australia.
| | | | | | | |
Collapse
|
48
|
Single pediatric kidney transplantation in adult recipients: comparable outcomes with standard-criteria deceased-donor kidney transplantation. Transplantation 2013; 95:1354-9. [PMID: 23507701 DOI: 10.1097/tp.0b013e31828a9493] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Single pediatric kidney transplantation (SKT) in adult recipients has traditionally been considered a high risk because of concerns of technical complications leading to poor graft outcomes. The primary goal of this single-center, retrospective analysis was to compare outcomes after SKT to standard-criteria deceased-donor kidney transplantation (SCDKT). METHODS We compared outcomes in adult recipients after SKT (n=31; mean donor weight, 27 kg); SCDKT (n=283); pediatric en bloc (n=21), living-donor (n=275), and extended criteria-donor (n=100) kidney transplantations. RESULTS The death-censored 5-year graft survival after SKT was significantly superior to SCDKT (81.4% vs. 74.5%, P=0.02). The serum creatinine level at 5 years after transplantation was significantly lower in SKT compared with that in SCDKT (1.2 vs. 1.6 mg/dL, P<0.0001). There was a significantly higher incidence of arterial anastomotic stenosis (6.8% vs. 0.4%, P=0.02) and hydronephrosis (12.9% vs. 5.3%, P=0.02) in the SKT cohort compared with SCDKT. Subgroup analysis of the SKT cohort by donor age less than 5 years vs. 6 to 10 years (mean weight, 16.4 vs. 32.7 kg) revealed no differences in patient or graft survival. CONCLUSIONS Despite a higher incidence of posttransplantation vascular and urological complications, long-term graft survival after SKT (in weight-matched pediatric donors and selected adult recipients) was comparable with that after SCDKT. SKT from very small donors (age, ≤5 years) yielded excellent long-term patient and graft survivals. The use of pediatric donor kidneys should be encouraged to address the problem of organ shortage.
Collapse
|
49
|
Current status of pediatric donor en bloc kidney transplantation to young adult recipients. Actas Urol Esp 2013; 37:383-6. [PMID: 23411068 DOI: 10.1016/j.acuro.2012.11.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Revised: 10/09/2012] [Accepted: 11/27/2012] [Indexed: 11/22/2022]
Abstract
CONTEXT AND OBJECTIVES In recent years, despite the increased number of kidney transplants performed in Spain, we observed a gradual increase in waiting lists. The need to increase the number of transplants performed in our centers, forces us to accept as donors patients previously rejected. ACQUIRING OF EVIDENCE We performed a systematic review using PubMed of published articles in the last 10 years, that include the words transplant renal en bloque, "en bloc kidney transplantation" or its initials EBKT. SYNTHESIS OF EVIDENCE The pediatric donor to adult recipient has been included in the expanded criteria donors group, being rejected nevertheless such donors in most centers. However, in recent published series comparing the en bloc kidney transplantation from pediatric donor to adult recipients with other transplanted groups, the authors observe similar results between this kind of transplantation and the "optimal" donor group or living kidney donor group, regarding renal function and graft survival, and better results than the transplanted kidneys with expanded criteria donors group. CONCLUSIONS The results published in the current series lead us to consider this kind of transplant as an option to increase the number of transplants performed.
Collapse
|
50
|
|