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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.
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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
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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.
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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
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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.
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Wijetunga I, Ecuyer C, Martinez-Lopez S, Jameel M, Baker RJ, Welberry Smith M, Patel C, Weston M, Ahmad N. Renal transplant from infant and neonatal donors is a feasible option for the treatment of end-stage renal disease but is associated with increased early graft loss. Am J Transplant 2018; 18:2679-2688. [PMID: 29981206 DOI: 10.1111/ajt.15006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 06/25/2018] [Accepted: 07/01/2018] [Indexed: 01/25/2023]
Abstract
Kidney transplants from young pediatric donors are uncommonly performed in the UK. Published literature of kidney transplant from donors weighing less than 5 kg is sparse. We present our initial experience of en bloc kidney transplantation (EKT) from donors weighing less than 20 kg, including neonatal donors. All recipients undergoing EKT from donors under 20 kg at our center from January 2005 to October 2016 were included. Donor and recipient details were recorded from a prospective database. Electronic patient records were examined for follow-up data. Of 30 EKTs included, 15 were from ≤5 kg donors and 15 from >5 kg donors (median weight 3.4 and 12.7 kg, respectively). One-year graft survival for ≤5 kg and >5 kg donors for EKT was 86.7% and 93.3% (P = 0.85), respectively. Progressive improvement in estimated GFR (eGFR) was noted in both donor categories through first-year posttransplant but in the ≤5 kg donor category significant improvement was seen at 12 months compared to 3 months after transplantation (median eGFR 37.3 vs 70.0 mL/min/1.73 m2 , P = 0.03). Two early graft losses were attributable to early vascular complications and one graft loss due to primary nonfunction. Our data show that kidney transplantation from such donors is a feasible option at centers with experience of EKT, albeit with increased risk of early graft loss.
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Affiliation(s)
- Imeshi Wijetunga
- Division of Surgery, Department of Transplantation, St James‧s University Hospital, Leeds, UK
| | - Clare Ecuyer
- Division of Surgery, Department of Transplantation, St James‧s University Hospital, Leeds, UK
| | - Sonsoles Martinez-Lopez
- Division of Surgery, Department of Transplantation, St James‧s University Hospital, Leeds, UK
| | - Muhammad Jameel
- Division of Surgery, Department of Transplantation, St James‧s University Hospital, Leeds, UK
| | - Richard J Baker
- Department of Renal Medicine, St James‧s University Hospital, Leeds, UK
| | | | - Chirag Patel
- Department of Radiology and Nuclear Medicine, St James‧s University Hospital, Leeds, UK
| | - Michael Weston
- Department of Radiology, St James‧s University Hospital, Leeds, UK
| | - Niaz Ahmad
- Division of Surgery, Department of Transplantation, St James‧s University Hospital, Leeds, UK
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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.
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Belatacept-based immunosuppression in a chagasic adult recipient of en bloc pediatric kidneys. Transplantation 2014; 98:e34-5. [PMID: 25140706 DOI: 10.1097/tp.0000000000000282] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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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.
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Affiliation(s)
- Frank Friedersdorff
- Department of Urology, Charité - Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
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