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White MH, Ross L, Gallo A, Parker WF. Graft Survival of En Bloc Deceased Donor Kidneys Transplants Compared With Single Kidney Transplants. Transplantation 2024:00007890-990000000-00773. [PMID: 38773845 DOI: 10.1097/tp.0000000000005058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2024]
Abstract
BACKGROUND The US Kidney Allocation System allocates en bloc deceased donor kidney grafts from donors <18 kg in sequence A along with single kidney transplants (SKTs) from kidney donor profile index (KDPI) top 20% donors. Although en bloc grafts outperform SKT grafts holding donor weight constant, it is unclear if en bloc grafts from the smallest pediatric donors perform the same as top 20% KDPI SKTs. METHODS Using the Scientific Registry of Transplant Recipients, we compared the donor characteristics and graft survival of en bloc grafts from the smallest donors (<8 kg) and from larger donors (≥8 kg) with SKTs by KDPI sequence for transplants performed in 2021. RESULTS Larger donor en blocs had similar 1-y survival to sequence A SKTs estimated by the Kaplan-Meier method (96% versus 96%, P = 0.9), but the smallest donor en blocs had significantly shorter 1-y survival than those SKTs (80% versus 96%, P < 0.01). Using transplants from 2010 to 2012, the smallest donor en blocs had similar 10-y survival to sequence A SKTs (69% versus 64%, P = 0.3). CONCLUSIONS These findings suggest that future updates of the Kidney Allocation System should include a score specific to pediatric donors to account for these differences in en bloc graft survival.
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Affiliation(s)
- Molly H White
- Department of Medicine, University of Chicago, Chicago, IL
| | - Lainie Ross
- Department of Health Humanities and Bioethics, University of Rochester, Rochester, NY
- Paul M Schyve MD Center for Bioethics, University of Rochester, Rochester, NY
| | - Amy Gallo
- Department of Surgery, Stanford University, Palo Alto, CA
| | - William F Parker
- Department of Medicine, University of Chicago, Chicago, IL
- Department of Public Health Sciences, University of Chicago, Chicago, IL
- Department of Medicine, MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, IL
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2
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Azzam A, Tawfeeq M, Obeid M, Khan I, Almaghrabi M, AlQahtani M, Alshami A. Pediatric en bloc kidney transplant from donors <15 kg: An excellent approach to expand the pediatric deceased donor pool. Pediatr Transplant 2024; 28:e14715. [PMID: 38553805 DOI: 10.1111/petr.14715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 01/09/2024] [Accepted: 01/30/2024] [Indexed: 04/02/2024]
Abstract
INTRODUCTION Most kidneys from small pediatric donors are transplanted to adult recipients because of the perceived risk of surgical complications and graft thrombosis. In this study, we aim to demonstrate our favorable outcomes in transplanting pediatric kidneys from donors <15 k into pediatric recipients. METHODS This study retrospectively analyzes the outcomes of seven pediatric recipients of en block kidney transplants from pediatric donors weighing <15 kg performed at King Fahad Specialist Hospital-Dammam from December 2014 to January 2018. Baseline characteristics of donors and recipients were collected. The incidences of surgical complication, immediate, and intermediate graft function were the primary outcomes. RESULTS The study included seven recipients monitored for a mean duration of 6.86 ± 1.35. Donors' and recipients' mean weights were 7.4 ± 3.2 kg and 20.7 ± 9.2 kg, respectively. Ureteric stricture occurred in one patient. There was a substantial improvement of 1-year estimated glomerular filtration rate (eGFR) compared to the 1-week mark (106.7 ± 26.38 mL/min. 1.73 m2 vs. 63.7 ± 22.92 mL/min/1.73 m2, p = .0069). The observed improvement in renal function persisted at the 5-year mark and during the last follow-up, with eGFR of 70.3 ± 40.7 mL/min/1.73 m2, and 79.8 ± 30.8 mL/min/1.73 m2, respectively. There was also increase of 27.9% in the size of the en bloc kidney observed at the 6 months. CONCLUSION In a specialized transplant center with highly skilled surgeons, the utilization of en bloc kidney transplant from donors weighing less than 15 kg is an effective strategy for expanding the donor pool and ensuring favorable graft outcomes.
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Affiliation(s)
- Ahmad Azzam
- Division of Pediatric Kidney Transplantation, Multi Organ Transplant Department, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Mansour Tawfeeq
- Transplant Surgery Department, Multi Organ Transplant Center, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Mahmoud Obeid
- Transplant Surgery Department, Multi Organ Transplant Center, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Iftikhar Khan
- Transplant Surgery Department, Multi Organ Transplant Center, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Mohammed Almaghrabi
- Division of Pediatric Kidney Transplantation, Multi Organ Transplant Department, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Mohammed AlQahtani
- Transplant Surgery Department, Multi Organ Transplant Center, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Alanoud Alshami
- Division of Pediatric Kidney Transplantation, Multi Organ Transplant Department, King Fahad Specialist Hospital, Dammam, Saudi Arabia
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Schild R, Carvajal Abreu K, Büscher A, Kanzelmeyer N, Lezius S, Krupka K, Weitz M, Prytula A, Printza N, Berta L, Saygılı 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 2024:00007890-990000000-00739. [PMID: 38685197 DOI: 10.1097/tp.0000000000004993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
BACKGROUND Kidney transplantation (KTx) from small donors is associated with inferior graft survival in registry studies, whereas single-center studies show favorable results. METHODS We compared 175 pediatric KTx from small donors ≤20 kg (SDKTx) with 170 age-matched recipients from adult donors (ADKTx) from 20 centers within the Cooperative European Paediatric Renal Transplant Initiative registry. Graft survival and estimated glomerular filtration rate (eGFR) were analyzed by Cox regression and mixed models. Detailed data on surgical and medical management were tested for association with graft survival. RESULTS One-year graft survival was lower after SDKTx compared with ADKTx (90.9% versus 96.5%; odds ratio of graft loss, 2.92; 95% confidence interval [CI], 1.10-7.80; P = 0.032), but 5-y graft survival was comparable (90.9% versus 92.7%; adjusted hazard ratio of graft loss 1.9; 95% CI, 0.85-4.25; P = 0.119). SDKTx recipients had an annual eGFR increase of 8.7 ± 6.2 mL/min/1.73 m² compared with a decrease of 6.9 ± 5.7 mL/min/1.73 m² in ADKTx recipients resulting in a superior 5-y eGFR (80.5 ± 25.5 in SDKTx versus 65.7 ± 23.1 mL/min/1.73 m² in ADKTx; P = 0.008). At 3 y posttransplant, eGFR after single SDKTx was lower than after en bloc SDKTx (86.6 ± 20.4 versus 104.6 ± 35.9; P = 0.043) but superior to ADKTx (68.1 ± 23.9 mL/min/1.73 m²). Single-kidney SDKTx recipients had a lower rate of hypertension at 3 y than ADKTx recipients (40.0% versus 64.7%; P = 0.008). CONCLUSIONS Compared with ADKTx, 5-y graft function is superior in SDKTx and graft survival is similar, even when performed as single KTx. Utilizing small donor organs, preferably as single kidneys in experienced centers, is a viable option to increase the donor pool for pediatric recipients.
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Affiliation(s)
- Raphael Schild
- Department of Pediatric Nephrology, Pediatric Hepatology and Pediatric Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Karla Carvajal Abreu
- Department of Pediatrics, University Children's Hospital, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anja Büscher
- Department of Pediatrics II, University Hospital of Essen, University of Essen-Duisburg, Essen, Germany
| | - Nele Kanzelmeyer
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany
| | - Susanne Lezius
- Department of Medical Biometry and Epidemiology, University Medical Center, Hamburg-Eppendorf, Germany
| | - Kai Krupka
- Department of Pediatrics I, University Children's Hospital, Heidelberg, Germany
| | - Marcus Weitz
- Department of General Pediatrics and Hematology/Oncology, University Children's Hospital Tübingen, Tübingen, Germany
| | - Agnieszka Prytula
- Paediatric Nephrology and Rheumatology Department, Ghent University Hospital, Ghent, Belgium
| | - Nikoleta Printza
- Pediatric Nephrology Unit, First Department of Pediatrics, Hippokratio General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - László Berta
- First Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Seha Kamil Saygılı
- Division of Pediatric Nephrology, Department of Pediatrics, İstanbul University-Cerrahpaşa, Cerrahpaşa School of Medicine, Istanbul, Turkey
| | - Anne-Laure Sellier-Leclerc
- Centre de Référence des Maladies Rénales Rares, Service de Néphrologie Pédiatrique, Hôpital Femme Mère Enfant, HCL, Bron Cedex, France
| | - Giuseppina Spartà
- Pediatric Nephrology, University Children's Hospital Zürich, Zurich, Switzerland
| | - Stephen D Marks
- Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Markus J Kemper
- Department of Pediatrics, Asklepios Klinik Nord Heidberg, Hamburg, Germany
| | - Sabine König
- Department of General Pediatrics, University Hospital Muenster, Muenster, Germany
| | - Rezan Topaloglu
- Department of Pediatric Nephrology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Dominik Müller
- Pediatric Nephrology, Charité Children's Hospital, Berlin, Germany
| | - Günter Klaus
- Department of Pediatrics II, University Children's Hospital, Philipps-University Marburg, Marburg, Germany
| | - Stefanie Weber
- Department of Pediatrics II, University Children's Hospital, Philipps-University Marburg, Marburg, Germany
| | - Jun Oh
- Department of Pediatric Nephrology, Pediatric Hepatology and Pediatric Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Uta Herden
- Department of Visceral Transplantation, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Andrea Carraro
- Pediatric Nephrology, Dialysis and Transplant Unit, Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
| | - Luca Dello Strologo
- Renal Transplant Unit, Bambino Gesù Children's Research Hospital IRCCS, Rome, Italy
| | - Gema Ariceta
- Division of Pediatric Nephrology, Hospital Universitari Vall d' Hebron, Barcelona, Spain
| | - Peter Hoyer
- Department of Pediatrics II, University Hospital of Essen, University of Essen-Duisburg, Essen, Germany
| | - Burkhard Tönshoff
- Department of Pediatrics I, University Children's Hospital, Heidelberg, Germany
| | - Lars Pape
- Department of Pediatrics II, University Hospital of Essen, University of Essen-Duisburg, Essen, Germany
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Kizilbash SJ, Evans MD, Vock DM, Chinnakotla S, Chavers BM. Should children receive a kidney transplant before 2 years of age? Pediatr Transplant 2024; 28:e14631. [PMID: 37937507 DOI: 10.1111/petr.14631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 09/28/2023] [Accepted: 10/16/2023] [Indexed: 11/09/2023]
Abstract
BACKGROUND The optimal age of kidney transplantation for infants and toddlers with kidney failure is unclear. We aimed to evaluate the patient survival associated with kidney transplantation before 2 years of age versus remaining on the waitlist until ≥2 years. METHOD We used the Scientific Registry of Transplant Recipients to identify all children added to the deceased-donor waitlist before 2 years of age between 1/1/2000 and 4/30/2020. For each case aged <2 years at transplant, we created a control group comprising all candidates on the waitlist on the case's transplant date. Patient survival was evaluated using sequential Cox regression. Dialysis-free time was defined as graft survival time for cases and the sum of dialysis-free time on the waitlist and graft survival time for controls. RESULTS We observed similar patient survival for posttransplant periods 0-3 and 4-12 months but higher survival for period >12 months for <2-year decreased-donor recipients (aHR: 0.32; 95% CI: 0.13-0.78; p = .01) compared with controls. Similarly, patient survival was higher for <2-year living-donor recipients for posttransplant period >12 months (aHR: 0.21; 95% CI: 0.06-0.73; p = .01). The 5-year dialysis-free survival was higher for <2-year deceased- (difference: 0.59 years; 95% CI: 0.23-0.93) and living-donor (difference: 1.84 years; 95% CI: 1.31-2.25) recipients. CONCLUSION Kidney transplantation in children <2 years of age is associated with improved patient survival and reduced dialysis exposure compared with remaining on the waitlist until ≥2 years.
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Affiliation(s)
- Sarah J Kizilbash
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA
| | - Michael D Evans
- Clinical and Translational Science Institute, University of Minnesota, Minneapolis, Minnesota, USA
| | - David M Vock
- Division of Biostatistics, University of Minnesota, Minneapolis, Minnesota, USA
| | | | - Blanche M Chavers
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA
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5
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Boyer O, Pape L. Is ABO Incompatible Living Donor Kidney Transplantation in Children a Better Option than the Use of Optimal Grafts From Deceased Donors? A Plea for Better Prioritization of Deceased Kidney Grafts for Children. Transpl Int 2023; 36:11911. [PMID: 37789913 PMCID: PMC10542672 DOI: 10.3389/ti.2023.11911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 09/01/2023] [Indexed: 10/05/2023]
Affiliation(s)
- Olivia Boyer
- Néphrologie Pédiatrique, Centre de Référence des Maladies Rénales Héréditaires de l’Enfant et l’Adulte, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, INSERM U1163, Institut Imagine, Université Paris Cité, Paris, France
| | - Lars Pape
- Department of Pediatric Nephrology, Children’s Hospital, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany
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6
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Ajmera J, Pol MM, Bagga A, Sinha A. Youngest en-bloc kidney transplant recipient in India: defying the barriers and challenges with teamwork. BMJ Case Rep 2023; 16:e254439. [PMID: 37258048 PMCID: PMC10254866 DOI: 10.1136/bcr-2022-254439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
We received a call from a transplant coordinator about the availability of a consented deceased donor. En-bloc kidneys with the aorta and IVC (inferior vena cava) were harvested from a toddler weighing 8 kg. The recipient was of early childhood weighing 14 kg who had been on haemodialysis for the last 3 years for end-stage kidney disease. He received anti-thymocyte globulin as an induction immunosuppressant. The kidneys were transplanted en bloc in the right lower quadrant retroperitoneal region; an anastomosis was performed to the recipient's aorta and IVC, and two separate neocystoureterostomies were created. His serum creatinine reached 0.5 mg/dL on the seventh postoperative day, following a few days of delayed graft function. In this study, we describe the surgical and non-surgical challenges that we faced while performing en-bloc kidney transplant to the youngest recipient and how a multidisciplinary team approach helped us overcome them.
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Affiliation(s)
- Jagadeep Ajmera
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Manjunath Maruti Pol
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Arvind Bagga
- Pediatrics, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Aditi Sinha
- Pediatrics, All India Institute of Medical Sciences, New Delhi, Delhi, India
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7
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Menchaca MG, Tulla K, Samra M, Samra J, Tzvetanov I, Setty S. Kidney Volume Growth and Kidney Function of en bloc Pediatric Kidney Transplants: A Case Series. Kidney Med 2023; 5:100616. [PMID: 37122394 PMCID: PMC10131106 DOI: 10.1016/j.xkme.2023.100616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
Abstract
Rationale & Objective Kidney transplant is a mainstay of kidney replacement therapy. Given a continued shortage of organs, pediatric en bloc kidney transplants may have substantial utility. We present our long-term experience with en bloc transplants from donors aged 3 to 60 months, including changes in kidney function and kidney volume over time as well as biopsy findings. Study Design Case series. Setting & Participants Medical records from a single academic medical center were reviewed. Aggregate serial volumes of 22 en bloc kidney allografts from 2010 to 2017 were assessed at the time of transplant and during follow-up. Estimated glomerular filtration rates (eGFR) were described at 3 months after transplant (baseline) as well as over the ensuing 3 years. Interstitial fibrosis, a finding determined by histopathologic review, which results from an accumulation of collagen that is produced from mediators produced from complex interaction of multiple inflammatory cells, was assessed on 20 protocol biopsies obtained from 6 patients, of which 4 patients had 4 biopsies and 2 patients had 1 biopsy. Results Kidney volume was obtained from 51 ultrasound studies performed up to 74 months after transplant. Kidney volume generally increased and eGFR rose over time after the transplant, with 23% patients achieving an eGFR of >75 mL/min/1.73 m2 at 3 months posttransplant. The remainder achieved an eGFR >75 mL/min/1.73 m2 over the ensuing 3 years. Interstitial fibrosis noted on biopsies appeared to foreshadow an eventual reduction in kidney volume. Limitations Retrospective study, possible selection bias, single-center experience. Conclusions The kidney en bloc allografts increased in size after transplantation, with associated improved kidney function. Chronic damage to the graft, from interstitial fibrosis and tubular atrophy, resulted in long-term reduction in kidney volume.
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8
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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.
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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
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9
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Engen RM, Smith JM, Bartosh SM. The kidney allocation system and pediatric transplantation at 5 years. Pediatr Transplant 2022; 26:e14369. [PMID: 35919967 DOI: 10.1111/petr.14369] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 07/07/2022] [Accepted: 07/17/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND A new Kidney Allocation System (KAS) was implemented in the United States in 2014 with the goal of improving equity and utility. METHODS In this study, we compare outcomes for kidney-alone candidates less than 18 years of age, at the time of listing, in the 5 years prior to and following policy implementation using Organ Procurement and Transplantation Network data. RESULTS While the pediatric deceased donor transplant rate increased under KAS, this increase was due solely to improved access for children aged 11-17 years; there was an 18.9% decrease in the deceased donor transplant rate among children 0-5 years old, from 117.94 to 95.8 transplants per 100 person-years (p = .001). The cumulative incidence of deceased donor transplantation by 1 year after listing decreased from 39.3% in the pre-KAS era to 35.5% in the post-KAS era (p = .004), a decline that was driven entirely by longer wait times for children 0-5 years old (p = .017). Candidates with a calculated panel reactive antibody of 98%-100% experienced a significant increase in transplant rate, but there was no change in transplant rate for Black or Hispanic candidates. CONCLUSION Overall, KAS increased transplantation access for teenaged and highly sensitized candidates but resulted in decreased access for the youngest children with no improvement in racial/ethnic equality.
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Affiliation(s)
- Rachel M Engen
- Department of Pediatrics, University of Wisconsin Madison, Madison, Wisconsin, USA
| | - Jodi M Smith
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | - Sharon M Bartosh
- Department of Pediatrics, University of Wisconsin Madison, Madison, Wisconsin, USA
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10
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Voet M, Cornelissen EAM, van der Jagt MFP, Lemson J, Malagon I. Perioperative anesthesia care for the pediatric patient undergoing a kidney transplantation: An educational review. Paediatr Anaesth 2021; 31:1150-1160. [PMID: 34379843 PMCID: PMC9292670 DOI: 10.1111/pan.14271] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 07/20/2021] [Accepted: 07/27/2021] [Indexed: 02/06/2023]
Abstract
Living-donor kidney transplantation is the first choice therapy for children with end-stage renal disease and shows good long-term outcome. Etiology of renal failure, co-morbidities, and hemodynamic effects, due to donor-recipient size mismatch, differs significantly from those in adult patients. Despite the complexities related to both patient and surgery, there is a lack of evidence-based anesthesia guidelines for pediatric kidney transplantation. This educational review summarizes the pathophysiological changes to consider and suggests recommendations for perioperative anesthesia care, based on recent research papers.
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Affiliation(s)
- Marieke Voet
- Department of Anesthesiology, Pain and Palliative MedicineRadboud University Medical CenterNijmegenthe Netherlands
| | - Elisabeth A. M. Cornelissen
- Department of Pediatric NephrologyRadboud University Medical CenterAmalia Children’s HospitalNijmegenthe Netherlands
| | - Michel F. P. van der Jagt
- Department of Vascular and Transplant SurgeryRadboud University Medical CenterNijmegenthe Netherlands
| | - Joris Lemson
- Department of Intensive Care MedicineRadboud University Medical CenterNijmegenthe Netherlands
| | - Ignacio Malagon
- Department of Anesthesiology, Pain and Palliative MedicineRadboud University Medical CenterNijmegenthe Netherlands
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11
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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.
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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
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Kizilbash SJ, Chavers BM. Strategies to Expand the Deceased Donor Pool for Pediatric Kidney Transplant Recipients. KIDNEY360 2020; 1:691-693. [PMID: 35372931 PMCID: PMC8815552 DOI: 10.34067/kid.0001772020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 05/15/2020] [Indexed: 06/14/2023]
Affiliation(s)
- Sarah J. Kizilbash
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Blanche M. Chavers
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
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