1
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Avilez ND, De Souza ABP, Domenico BRD, Prates LC, Mazzali M, De Lima ML. Analysis of Factors Related to the Success of Pediatric Kidney Transplantation: A 35 Years Experience. Transplant Proc 2024; 56:44-49. [PMID: 38216360 DOI: 10.1016/j.transproceed.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 10/15/2023] [Accepted: 11/26/2023] [Indexed: 01/14/2024]
Abstract
BACKGROUND Despite the significant improvement results over the past 20 years, pediatric kidney transplantation remains a challenge. Chronic rejection, thrombosis, and recurrence of the primary disease are frequent causes of graft loss that have been little studied. Therefore, our objective is to analyze factors related to a better prognosis, which can be used to improve future strategies to allow higher pediatric transplant success rates. METHODS A retrospective cohort study with patients under 15 years old submitted for kidney transplantation at the Hospital das Clínicas da UNICAMP between January 1, 1987, and January 1, 2022. Age, patient weight, time and type of dialysis, use of anticoagulation, complications, ischemia time, and donor weight were analyzed and related to graft loss. The significance level adopted for the statistical tests was 5%. RESULTS One hundred ninety-two medical records were anaThe mean follow-up time was 11 years, and the mean graft duration was ration 8.5 years. The main causes of graft loss were chronic dysfunction, thrombosis, and acute cellular rejection. Thrombosis presented significantly with the donor's body mass index and second transplantation. There was no correlation between the analyzed variables and chronic dysfunction or acute cellular rejection. DISCUSSION Thrombosis remains the main cause of early graft loss, followed by acute cellular rejection. Measures such as thrombophilia screening and thromboprophylaxis have been proposed to improve results. However, they are still not standardized. CONCLUSION The main causes of graft loss were chronic dysfunction, thrombosis, and acute cellular rejection. Only the thrombosis was related to the donor's body mass index and a second transplantation.
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Affiliation(s)
| | | | | | - Liliane Cury Prates
- Department of Pediatric Nephrology, University of Campinas - UNICAMP - Sao Paulo, Brazil
| | - Marilda Mazzali
- Department of Nephrology, University of Campinas - UNICAMP - Sao Paulo, Brazil
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2
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Zhang Q, Su X, Liu L, Huang M, Wu W, Zhang H, Wu C, Fu Q, Gao P, Ling L, Chen W, Xu B, Liao Y, Li J, Wang C. The Outcome of Transplanting Kidneys From Very Small Pediatric Deceased Donors. Transplantation 2023; 107:1564-1572. [PMID: 36788440 DOI: 10.1097/tp.0000000000004534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
BACKGROUND Kidneys from very small pediatric donors (VSPDs, aged <2 y) are underutilized. Concerns regarding potentially inferior outcomes hinder the use in pediatric recipients. METHODS All pediatric kidney-only transplants from <18-year-old donors between January 2012 and May 2021 in our center were included in this study. Outcomes were compared between VSPD and normal pediatric donor (NPD, aged 2-18 y) groups, and 3-y death-censored graft survival was assessed by the multivariable Cox proportional hazard model. RESULTS Of all 252 enrolled patients, 149 (59.1%) received kidneys from NPDs and 103 (40.9%) from VSPDs. The 3-y graft survival rates of the NPD and VSPD groups were 91.2% and 88.6%, respectively ( P = 0.385). The adjusted hazard ratio of 3-y graft loss was 1.2 (95% confidence interval, 0.6-2.5; P = 0.659) for the VSPD group compared with the NPD group. There was no significant difference in estimated glomerular filtration rate at 3 y posttransplant observed between NPD and VSPD groups (86.9 ± 26.8 versus 87 ± 27.9 mL/min/1.73 m 2 ; P = 0.991). Patients (n = 12, 4.8%) who received kidneys from donors <5 kg contributed 5 (5/39, 12.8%) with delayed graft function and the sole primary nonfunction in our cohort. CONCLUSIONS Although attention to preventing complications is necessary, especially for kidneys from donors <5 kg, kidneys from VSPDs did not appear to impart added risk for 3-y graft loss and renal function.
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Affiliation(s)
- Qiang Zhang
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiaojun Su
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Longshan Liu
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Mingchuan Huang
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Wenrui Wu
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Huanxi Zhang
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Chenglin Wu
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Qian Fu
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Pengfei Gao
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Liuting Ling
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Wenting Chen
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Bowen Xu
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yuan Liao
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jun Li
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Changxi Wang
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, China
- Guangdong Provincial Key Laboratory Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, China
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3
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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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4
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Bajaj S, Gershony S, Afshar K, Blydt-Hansen TD. Clinical indicators of slow graft function and outcome after pediatric kidney transplantation. Pediatr Transplant 2022; 26:e14353. [PMID: 35781749 DOI: 10.1111/petr.14353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 06/06/2022] [Accepted: 06/07/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Lesser degrees of perioperative ischemia-reperfusion injury that does not require dialysis may nonetheless influence allograft outcomes, necessitating evaluation of suitable surrogate indicators of perioperative allograft injury. METHODS This retrospective analysis of pediatric kidney transplants evaluated two indicators representing pace and completeness of recovery, for association with 12-month estimated glomerular filtration rate (eGFR) and first-year rate of eGFR decline: time to creatinine nadir (TTN) and ratio of recipient/donor unadjusted GFR (uGFRR/D ) at 1-month post-transplant. Donor, recipient, and perioperative risk factors were tested further for association with these 2 indicators. RESULTS 179 patients (190 transplants) aged 13 (IQR 7-17) years and 56% male were included. Twelve-month eGFR was strongly associated with unadjusted GFR at 1 month (uGFR1M , p < .001) and uGFRR/D (p = .003), but not with TTN. None of the indicators was associated with the rate of subsequent eGFR decline after 1-month post-transplant. As a potential surrogate indicator, uGFR1M is effectively modeled by TTN and uGFRR/D (adjusted R2 = 0.57) and is associated with 12-month eGFR (β = 0.81 ± 0.08; p < .001). Clinical factors associated with uGFRR/D included donor uGFR (p < .001), BSA (p = .026), age (p = .074), and recipient BSA (p < .001). Factors associated with pace of recovery (TTN) included donor uGFR (p = .018), type (p = .019), and recipient BSA (p = .022). CONCLUSIONS The uGFRR/D ratio, but not TTN, is a useful indicator of perioperative allograft damage that is associated with one-year functional outcome; and uGFR1M is a potential early surrogate outcome. Donor, recipient, and perioperative factors that are associated with slow allograft function are identified.
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Affiliation(s)
- Sargun Bajaj
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sharon Gershony
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kourosh Afshar
- Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tom David Blydt-Hansen
- Department of Pediatrics (Nephrology), University of British Columbia, Vancouver, British Columbia, Canada
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5
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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.
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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
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6
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Peng J, Dai H, Zhang H, Yu S, Xie X, Peng F, Lan G, Hu S, Wang Y, Tang X, Guo Y, Gao C, Fang C, Nie M, Yuan X, Zhong M, Tang Z, Li T, Sun S, Yao H, Hou J, Huang R, Peng L. Comparison of Outcomes of Kidney Transplantation From Extremely Low Body Weight ≤5kg Versus Larger Body Weight Pediatric Donors. Front Immunol 2021; 12:738749. [PMID: 34531876 PMCID: PMC8438242 DOI: 10.3389/fimmu.2021.738749] [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] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 08/16/2021] [Indexed: 12/15/2022] Open
Abstract
Background Kidney transplantation from donors who weigh ≤5 kg is performed at only a few transplant centers owing to the high complication and low graft survival rates associated with this approach. Methods We retrospectively compared the results of kidney transplantation at our center between January 2015 and December 2019 based on the following pediatric donor criteria: donor body weight ≤5 kg (n=32), 5 kg< donor weight ≤20 kg (n=143), and donor weight >20 kg (n=110). We also perform subgroup analysis of kidney transplantation outcomes from ≤5 kg donors, using conventional (dual separate and classic en-bloc KTx)/novel (en-bloc KTx with outflow tract) surgical methods and allocating to adult/pediatric recipients. Results The death-censored graft survival rates from extremely low body weight ≤5kg at 1 month, and 1, 3, and 5 years were 90.6%, 80.9%, 77.5%, and 73.9%, respectively, which were significantly lower than that from larger body weight pediatric donors. However, the 3-, and 5-year post-transplantation eGFRs were not significantly different between the pediatric and adult recipient group. The thrombosis (18.8%) and urinary leakage (18.8%) rates were significantly higher in the donor weight ≤5 kg group. Compared with 5 kg< donor weight ≤20 kg group, donor weight ≤5kg group was at elevated risk of graft loss due to thrombosis (OR: 13.4) and acute rejection (OR: 6.7). No significant difference on the outcomes of extremely low body weight donor kidney transplantation was observed between adults and pediatric recipients. Urinary leakage rate is significantly lower in the novel operation (8.7%) than in the conventional operation group (44.4%). Conclusions Although the outcomes of donor body weight ≤5kg kidney transplantation is inferior to that from donors with large body weight, it can be improved through technical improvement. Donors with body weight ≤5 kg can be considered as an useful source to expand the donor pool.
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Affiliation(s)
- Jiawei Peng
- Department of Kidney Transplantation, The Second Xiangya Hospital of Central South University, Changsha, China.,Clinical Research Center for Organ Transplantation in Hunan Province, Changsha, China
| | - Helong Dai
- Department of Kidney Transplantation, The Second Xiangya Hospital of Central South University, Changsha, China.,Clinical Research Center for Organ Transplantation in Hunan Province, Changsha, China.,Clinical Immunology Center, Central South University, Changsha, China
| | - Hedong Zhang
- Department of Kidney Transplantation, The Second Xiangya Hospital of Central South University, Changsha, China.,Clinical Research Center for Organ Transplantation in Hunan Province, Changsha, China
| | - Shaojie Yu
- Department of Kidney Transplantation, The Second Xiangya Hospital of Central South University, Changsha, China.,Clinical Research Center for Organ Transplantation in Hunan Province, Changsha, China
| | - Xubiao Xie
- Department of Kidney Transplantation, The Second Xiangya Hospital of Central South University, Changsha, China.,Clinical Research Center for Organ Transplantation in Hunan Province, Changsha, China
| | - Fenghua Peng
- Department of Kidney Transplantation, The Second Xiangya Hospital of Central South University, Changsha, China.,Clinical Research Center for Organ Transplantation in Hunan Province, Changsha, China
| | - Gongbin Lan
- Department of Kidney Transplantation, The Second Xiangya Hospital of Central South University, Changsha, China.,Clinical Research Center for Organ Transplantation in Hunan Province, Changsha, China
| | - Shanbiao Hu
- Department of Kidney Transplantation, The Second Xiangya Hospital of Central South University, Changsha, China.,Clinical Research Center for Organ Transplantation in Hunan Province, Changsha, China
| | - Yu Wang
- Department of Kidney Transplantation, The Second Xiangya Hospital of Central South University, Changsha, China.,Clinical Research Center for Organ Transplantation in Hunan Province, Changsha, China
| | - Xiaotian Tang
- Department of Kidney Transplantation, The Second Xiangya Hospital of Central South University, Changsha, China.,Clinical Research Center for Organ Transplantation in Hunan Province, Changsha, China
| | - Yong Guo
- Department of Kidney Transplantation, The Second Xiangya Hospital of Central South University, Changsha, China.,Clinical Research Center for Organ Transplantation in Hunan Province, Changsha, China
| | - Chen Gao
- Department of Kidney Transplantation, The Second Xiangya Hospital of Central South University, Changsha, China.,Clinical Research Center for Organ Transplantation in Hunan Province, Changsha, China
| | - Chunhua Fang
- Department of Kidney Transplantation, The Second Xiangya Hospital of Central South University, Changsha, China.,Clinical Research Center for Organ Transplantation in Hunan Province, Changsha, China
| | - Manhua Nie
- Department of Kidney Transplantation, The Second Xiangya Hospital of Central South University, Changsha, China.,Clinical Research Center for Organ Transplantation in Hunan Province, Changsha, China
| | - Xiaoqiong Yuan
- Department of Kidney Transplantation, The Second Xiangya Hospital of Central South University, Changsha, China.,Clinical Research Center for Organ Transplantation in Hunan Province, Changsha, China
| | - Mingda Zhong
- Department of Kidney Transplantation, The Second Xiangya Hospital of Central South University, Changsha, China.,Clinical Research Center for Organ Transplantation in Hunan Province, Changsha, China
| | - Zhouqi Tang
- Department of Kidney Transplantation, The Second Xiangya Hospital of Central South University, Changsha, China.,Clinical Research Center for Organ Transplantation in Hunan Province, Changsha, China
| | - Tengfang Li
- Department of Kidney Transplantation, The Second Xiangya Hospital of Central South University, Changsha, China.,Clinical Research Center for Organ Transplantation in Hunan Province, Changsha, China
| | - Siyu Sun
- Department of Kidney Transplantation, The Second Xiangya Hospital of Central South University, Changsha, China.,Clinical Research Center for Organ Transplantation in Hunan Province, Changsha, China
| | - Hengchang Yao
- Department of Kidney Transplantation, The Second Xiangya Hospital of Central South University, Changsha, China.,Clinical Research Center for Organ Transplantation in Hunan Province, Changsha, China
| | - Jianfei Hou
- Department of Kidney Transplantation, The Second Xiangya Hospital of Central South University, Changsha, China.,Clinical Research Center for Organ Transplantation in Hunan Province, Changsha, China
| | - Ruixue Huang
- Department of Occupational and Environmental Health, Xiangya School of Public Health, Central South University, Changsha, China
| | - Longkai Peng
- Department of Kidney Transplantation, The Second Xiangya Hospital of Central South University, Changsha, China.,Clinical Research Center for Organ Transplantation in Hunan Province, Changsha, China.,Clinical Immunology Center, Central South University, Changsha, China
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7
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Pediatric kidney transplantation in China: an analysis from the IPNA Global Kidney Replacement Therapy Registry. Pediatr Nephrol 2021; 36:685-692. [PMID: 32929532 DOI: 10.1007/s00467-020-04745-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 07/12/2020] [Accepted: 08/25/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND The International Pediatric Nephrology Association (IPNA) Global Kidney Replacement Therapy (KRT) Registry was established to evaluate the incidence and outcomes of kidney replacement therapy (dialysis and transplantation) provided to children worldwide. Analysis of registry data for separate regions is feasible. METHODS Three centers located in Shanghai, Guangzhou, and Zhengzhou, which have the greatest number of pediatric kidney transplantation cases in China, participated in this analysis of transplant data. Data were registered by each center for patients under the age of 19 years who received a single-organ kidney transplant for the first time between 2011 and 2018. RESULTS In total, 415 patients (59.8% male) aged 1.4-18.7 (median 12.1) years were followed for 0.3-97.1 (median 27.7) months. The number of kidney transplants increased from a total of 129 during 2011-2014 to 286 cases during 2015-2018. 85.8% of patients received the transplanted kidney from a pediatric (age < 19 years) donor, and deceased donors accounted for 94% of all donors. 8.0% of grafts were lost. One and 5-year patient survival rates were 97.6% and 95.5%, respectively. The major cause of death was infection (7/14). Similar graft and patient survival rates were observed for organs from pediatric and adult donors in 6-11 and 12-18 year recipient age groups, whereas recipients < 6 years showed inferior patient and graft survival. CONCLUSIONS Pediatric kidney transplantation shows favorable short-term and medium-term outcomes in China. Our experience supports use of pediatric donors in pediatric kidney transplantation, but attention directed to the outcome of recipients aged under 6 is necessary. Graphical abstract.
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8
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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.
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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
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9
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Bjerre A, Mjøen G, Line PD, Naper C, Reisaeter AV, Åsberg A. Five decades with grandparent donors: The Norwegian strategy and experience. Pediatr Transplant 2020; 24:e13751. [PMID: 32485019 DOI: 10.1111/petr.13751] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 04/17/2020] [Accepted: 05/06/2020] [Indexed: 11/29/2022]
Abstract
Living donors (LDs) are preferred over DDs for renal transplantation in children due to superior GS. Oslo University Hospital has never restricted living donation by upper age. The aim of this study was to investigate long-term outcomes using grandparents (GPLD) compared to PLD. Retrospective nationwide review in the period 1970-2017. First renal graft recipients using a GPLD were compared to PLD kidney recipients for long-term renal function and GS. 278 children (≤18 years) received a first renal transplant: 27/251 recipients with a GPLD/PLD. GPLD (median 59 (42-74) years) were significantly older than PLD (median 41 (23-65) years, (P < .001). Median DRAD was 52 (38-70) vs 28 (17-48) years, respectively. GS from GPLD and PLD had a 1-, 5-, and 10-year survival of 100%, 100%, and 90% vs 93%, 82%, and 72%, respectively (P = .6). In a multivariate Cox regression analysis adjusted for gender, donor age, recipient age, and year of transplant, this finding was similar (HR 0.98; 95% CI 0.34-2.84, P = .97). Five-year eGFR was 47.3 and 59.5 mL/min/1.73 m2 in the GPLD and PLD groups (P = .028), respectively. In this nationwide retrospective analysis, GS for pediatric renal recipients using GPLD was comparable to PLD. Renal function assessed as eGFR was lower in the GPLD group. The GPLD group was significantly older than the PLD group, but overall this did not impact transplant outcome. Based on these findings, older age alone should not exclude grandparent donations.
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Affiliation(s)
- Anna Bjerre
- Department of Pediatrics, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,University of Oslo, Oslo, Norway
| | - Geir Mjøen
- Department of Transplantation Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Pål-Dag Line
- University of Oslo, Oslo, Norway.,Department of Transplantation Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Christian Naper
- Department of Immunology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Anna Varberg Reisaeter
- Department of Transplantation Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,Norwegian Renal Registry, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Anders Åsberg
- Department of Transplantation Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,Norwegian Renal Registry, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,Department of Pharmacy, University of Oslo, Oslo, Norway
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10
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Amesty MV, Fernandez C, Espinosa L, Rivas-Vila S, Lobato R, Monsalve S, Lopez-Pereira PC, Martinez-Urrutia MJ. Long-term outcomes of adult-size and size-matched kidney transplants in small pediatric recipients. J Pediatr Urol 2020; 16:481.e1-481.e8. [PMID: 32493667 DOI: 10.1016/j.jpurol.2020.05.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 05/06/2020] [Accepted: 05/09/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Adult-size kidneys are usually used for kidney transplantation in small pediatric recipients, but the influence of graft size in transplant outcome remains controversial. Our aim is to compare long-term transplant outcomes of using adult-size and size-matched kidneys in small pediatric recipients. MATERIALS AND METHODS Since 1999, 61 of 226 kidney transplants were achieved in recipients weighing <20 kg with 5 years of follow-up. Patients were analyzed according to the graft size received: (group-A) adult-size (n = 32), (group-B) size-matched (n = 29). Kidney size (KS), glomerular filtration rate (GFR) proteinuria and rejection were compared between groups at transplant time (T0), at one (T1), two (T2), five years (T5), and at the end of the follow-up (TF) (median follow-up 8.47(0-17) years). Graft and patient survival were determined and compared between groups. RESULTS Mean KS was significantly different between groups at T0 (A:11.3 ± 1.1 cm, B:8.8 ± 0.9 cm), (pT0<0.01), group-B evidenced graft growth, reaching similar sizes to group-A at T5 (A:11.7±1 cm, B:11.2±1 cm; pT5 = 0.13) and TF (A:12.2 ± 1.1 cm, B:12.4 ± 1.2 cm; pTF = 0.63), and group-A had a slight graft growth at TF (pT0-TF<0.01). Mean Schwartz-GFR at T0 was greater in group-A (138 ± 33 ml/min/1.73 m2) than group-B (109 ± 34 mL/min/1.73 m2) (pT0 = 0.01); during follow-up, it evidenced a reduction in group-A (T5:90 ± 27, TF:71 ± 24 mL/min/1.73 m2; pT0-T5<0.01; pT0-TF<0.01), meanwhile in group-B was stable until T5 (104 ± 33 mL/min/1.73 m2; pT0-T5 = 0.54), declining at TF (76 ± 31 mL/min/1.73 m2; pT0-TF<0.01); with no significant differences at T1, T2, T5, and TF between groups. Similar results were observed in mean Filler-GFR of both groups (Figure). Proteinuria and episodes of rejection were no significantly different between groups during the follow-up (p > 0.01; p = 0.23). Graft and patient survival at 5 and 10 years did not show significant differences (p = 0.45; p = 0.10). DISCUSSION Despite the initial kidney size difference between groups, we have demonstrated that they tended to the same size during the follow-up. Adult-size kidneys presented a slight size increase in the long-term, suggesting that they have some growth potential in small recipients, in contrast to previous literature. Mean GFR between groups showed no significant differences in the long-term, suggesting that optimal graft perfusion and function can be achieved despite the size of the graft. We have demonstrated that there were no significant differences in long-term graft and patient survival; this results were similar to the most recent literature about this topic and different from the 90-2000s decades literature. CONCLUSIONS Adult-size kidneys may be transplanted to small recipients (<20 kg) with comparable outcomes to size-matched kidneys, with no significant differences in long-term KS, GFR, proteinuria, rejection, graft or patient survival.
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Affiliation(s)
- Maria Virginia Amesty
- Department of Pediatric Urology, Hospital Universitario La Paz, Paseo de La Castellana 261, 28046, Madrid, Spain.
| | - Carlota Fernandez
- Department of Pediatric Nephrology, Hospital Universitario La Paz, Paseo de La Castellana 261, 28046, Madrid, Spain
| | - Laura Espinosa
- Department of Pediatric Nephrology, Hospital Universitario La Paz, Paseo de La Castellana 261, 28046, Madrid, Spain
| | - Susana Rivas-Vila
- Department of Pediatric Urology, Hospital Universitario La Paz, Paseo de La Castellana 261, 28046, Madrid, Spain
| | - Roberto Lobato
- Department of Pediatric Urology, Hospital Universitario La Paz, Paseo de La Castellana 261, 28046, Madrid, Spain
| | - Shirley Monsalve
- Department of Pediatric Urology, Hospital Universitario La Paz, Paseo de La Castellana 261, 28046, Madrid, Spain
| | - Pedro Carlos Lopez-Pereira
- Department of Pediatric Urology, Hospital Universitario La Paz, Paseo de La Castellana 261, 28046, Madrid, Spain
| | - Maria Jose Martinez-Urrutia
- Department of Pediatric Urology, Hospital Universitario La Paz, Paseo de La Castellana 261, 28046, Madrid, Spain
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11
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Muramatsu M, Hamasaki Y, Mizutani T, Takahashi Y, Hashimoto J, Kubota M, Oguchi H, Yonekura T, Sakurabayashi K, Aoki Y, Shinoda K, Itabashi Y, Kawamura T, Shiraga N, Mikami T, Shibuya K, Sakai K, Shishido S. Comparison of live donor predonation and post-transplant kidney volumes and glomerular size in pediatric patients weighing less than 15 kg - a retrospective study. Transpl Int 2020; 33:878-886. [PMID: 32145105 DOI: 10.1111/tri.13602] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 10/18/2019] [Accepted: 03/02/2020] [Indexed: 11/28/2022]
Abstract
Renal transplantation of adult-size kidneys presents a size mismatch in small children. This study presents a comparison of live donor predonation and recipient post-transplant kidney volumes (k-vol) and glomerular size at 1 year after transplantation. We analyzed 47 pediatric renal transplant recipients weighing <15 kg between 2009 and 2017. The k-vol before and 1 year after transplantation and glomerular size at implant and 1 year post-transplant were evaluated. We estimated the relationships between these changes and graft function, and the factors associated with k-vol. Pretransplant k-vol was 158.1 ± 25.1 ml, and the k-vol at 1 year post-transplant was significantly reduced by -17.2% to 132.3 ± 27.3 ml (P < 0.001). Implant glomerular size showed the diameter was 165.3 ± 15.1 µm and the area 20 737.1 ± 3230.6 µm2 . One-year post-transplant, the glomerular diameter was 150.6 ± 11.4 µm and the area 17 428.3 ± 2577.9 µm2 , significantly reduced compared with implantation values (both P < 0.001). The change in k-vol was affected by pretransplant abdominal cavity (ml/200 ml cavity volume, partial regression coefficient = 0.029, SE = 0.009, P = 0.004) and recipient's weight gain (ml/5% of weight gain, partial regression coefficient = 0.020, SE = 0.006, P = 0.002). In small pediatric transplants, an adult-size kidney is acceptable with reduction in k-vol. Moreover, the post-transplant k-vol might be regulated by pretransplant physique and post-transplant somatic growth.
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Affiliation(s)
- Masaki Muramatsu
- Department of Nephrology, Toho University, Faculty of Medicine, Tokyo, Japan
| | - Yuko Hamasaki
- Department of Nephrology, Toho University, Faculty of Medicine, Tokyo, Japan
| | - Toshihide Mizutani
- Department of Nephrology, Toho University, Faculty of Medicine, Tokyo, Japan
| | - Yusuke Takahashi
- Department of Nephrology, Toho University, Faculty of Medicine, Tokyo, Japan
| | - Junya Hashimoto
- Department of Nephrology, Toho University, Faculty of Medicine, Tokyo, Japan
| | - Mai Kubota
- Department of Nephrology, Toho University, Faculty of Medicine, Tokyo, Japan
| | - Hideyo Oguchi
- Department of Nephrology, Toho University, Faculty of Medicine, Tokyo, Japan
| | - Takashi Yonekura
- Department of Nephrology, Toho University, Faculty of Medicine, Tokyo, Japan
| | - Kei Sakurabayashi
- Department of Nephrology, Toho University, Faculty of Medicine, Tokyo, Japan
| | - Yujiro Aoki
- Department of Nephrology, Toho University, Faculty of Medicine, Tokyo, Japan
| | - Kazunobu Shinoda
- Department of Nephrology, Toho University, Faculty of Medicine, Tokyo, Japan
| | - Yoshihiro Itabashi
- Department of Nephrology, Toho University, Faculty of Medicine, Tokyo, Japan
| | - Takeshi Kawamura
- Department of Nephrology, Toho University, Faculty of Medicine, Tokyo, Japan
| | - Nobuyuki Shiraga
- Department of Radiology, Toho University, Faculty of Medicine, Tokyo, Japan
| | - Tetuo Mikami
- Department of Pathology, Toho University, Faculty of Medicine, Tokyo, Japan
| | - Kazutoshi Shibuya
- Department of Surgical Pathology, Toho University, Faculty of Medicine, Tokyo, Japan
| | - Ken Sakai
- Department of Nephrology, Toho University, Faculty of Medicine, Tokyo, Japan
| | - Seiichiro Shishido
- Department of Nephrology, Toho University, Faculty of Medicine, Tokyo, Japan
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12
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Kim JK, Lorenzo AJ, Farhat WA, Chua ME, Ming JM, Dos Santos J, Koyle MA. A comparison of post-transplant renal function in pre-emptive and post-dialysis pediatric kidney transplant recipients. Pediatr Transplant 2019; 23:e13377. [PMID: 30735602 DOI: 10.1111/petr.13377] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Revised: 01/14/2019] [Accepted: 01/18/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE Little is known regarding post-transplant renal function following pediatric pre-emptive KT. Therefore, this study aims to determine whether there is a difference in 1 year post-transplant renal function outcomes between pre-emptive and post-dialysis KT in pediatric transplant recipients. METHODS A retrospective review of patients who underwent kidney transplant at our institution between 2000 and 2015 was performed. Kidney transplant recipients were divided into four groups: pre-DD, post-DD, pre-LD, and post-LD. The clinical outcomes, measured in eGFR (mL/min/1.73 m2 ), acute rejection episodes within 1 year, and hospitalization within 1 year were compared to between groups in their respective donor types (pre-DD vs post-DD; pre-LD vs post-LD). RESULTS The 324 patients were identified (21 pre-DD, 151 post-DD, 54 pre-LD, and 98 post-LD). Post-DD group had more females (P = 0.018) and post-operative complications (P = 0.023), although there was no difference in complications requiring intervention (P = 0.129). Post-LD patients were more likely to be females (P = 0.017) and those with intrinsic renal (non-urological/structural) ESRD etiology (P = 0.003). The 1-year eGFR was similar between pre-DD and post-DD groups (70.3 [IQR 53.5-88.5] vs 74.3 [IQR 62.3-90.5], P = 0.613), as well as pre-LD and post-LD groups (66.6 [IQR 47.8-73.7] vs 63.9 [IQR 55.0-77.1], P = 0.600). There were no significant differences in rates of acute rejection episodes or hospitalization within 1 year of transplantation for in LD/DD groups. CONCLUSION There is no significant difference in renal function at 1 year post-transplant in pediatric patients receiving pre-emptive or post-dialysis kidney transplants.
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Affiliation(s)
- Jin K Kim
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Division of Urology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Armando J Lorenzo
- Division of Urology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Walid A Farhat
- Division of Urology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Michael E Chua
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,nstitute of Urology, St. Luke's Medical Center, Quezon City, Philippines
| | - Jessica M Ming
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Surgery, University of New Mexico, Albuquerque, NM, USA
| | - Joana Dos Santos
- Division of Urology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Martin A Koyle
- Division of Urology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Surgery, University of Toronto, Toronto, Ontario, Canada
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13
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Martinez-Mier G, Mendez-Lopez MT, Soto-Miranda E, Moreno-Ley PI, Budar-Fernandez LF, Rizo-Velazquez CG, Vega-Rojano L. Acute Rejection Is a Strong Negative Predictor of Graft Survival in Living-Donor Pediatric Renal Transplant: 10-Year Follow-Up in a Single Mexican Center. EXP CLIN TRANSPLANT 2019; 17:170-176. [PMID: 30945629 DOI: 10.6002/ect.2017.0265] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Kidney transplant is the optimal treatment for children with end-stage renal disease. Multiple factors affect patient and graft survival. We assessed determinants of long-term patient/graft survival in our center by a retrospective review of pediatric living donor (< 18 years) kidney transplants from February 2003 to December 2016. MATERIALS AND METHODS Donor and recipient demo-graphic data and immunosuppression use were gathered for analyses. Transplant outcomes included patient/graft survival, acute rejection, and 1-year estimated glomerular filtration rate. Patient/graft survival results were analyzed by Kaplan-Meier, and Cox proportional hazards regression model was used for risk factors (univariate/multivariate). P ≤ .05 was statistically significant. RESULTS Ninety-nine patients were included. Age was 13.4 ± 3.08 years, 64.6% were male, and 88.9% were on dialysis with time of 17.1 ± 12.6 months. Mean donor age was 36.6 ± 7.7 years, and most were females (63.6%). Donor estimated glomerular filtration rate was 89.4 ± 16.9 mL/min/1.73 m2. HLA match was 3.2 ± 1.05. Panel reactive antibody showed 8.6 ± 20.5%. Of total patients, 47.5% used induction, 88.9% used cyclo-sporine, and 100% used mycophenolate mofetil. Five- and 10-year patient survival rates were 93.2% and 93.2%. One-year acute rejection was 14.1%, with rate of 24.2% throughout follow-up. One-year estimated glomerular filtration rate was 76.4 ± 25.6 mL/min/1.73 m2. Five- and 10-year graft survival rates were 62.6% and 43.3%. Multivariate analysis confirmed donor age and acute rejection episodes throughout follow-up as risk factors for graft survival (P < .05). CONCLUSIONS Acute rejection and donor age are important risk factors for 10-year graft survival in living-donor pediatric kidney transplant in our program.
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Affiliation(s)
- Gustavo Martinez-Mier
- From the Research Department and the Organ Transplantation Department, UMAE Hospital Especialidades 14 "Adolfo Ruiz Cortines" IMSS, Veracruz, Mexico
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14
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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.
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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
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15
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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.
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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
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16
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Odeh RI, Sidler M, Skelton T, Zu'bi F, Naoum NK, Azzawayed IA, Alyami FA, Lorenzo AJ, Farhat WA, Koyle MA. Intraoperative blood transfusion in pediatric patients undergoing renal transplant-Effect of renal graft size. Pediatr Transplant 2018; 22:e13119. [PMID: 29488289 DOI: 10.1111/petr.13119] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/13/2017] [Indexed: 11/29/2022]
Abstract
In pediatric RT, donor allograft size often exceeds the expected recipient norms, especially in younger recipients. An "oversize" graft might not only present a technical- and space-related challenge, but may possibly lead to increased demands in perioperative volume requirements due to the disparity between donor and recipient in renal blood flow. We evaluated transfusion practices at a single tertiary institution with special consideration of kidney graft size, hypothesizing that oversize graft kidneys might lead to a quantifiable increased need of blood transfusion in smaller recipients. Retrospective analysis of all patients who underwent pediatric RT from January 2004 to June 2014 at a tertiary pediatric centre was performed. Variables analyzed included patient age, weight, pre- and postoperative Hb concentration, graft size, EBL, amount of intraoperative blood transfusion, and preoperative use of erythropoietin. Based on graft size in relation to patient's age, a SMR and an OvR were identified. A subcohort of age-matched pairs was used to allow for comparison between groups. We calculated the expected procedure- and transfusion-induced changes in Hb and compared these changes to the observed difference in pre- vs postoperative Hb to assess the influence of graft size on transfusion requirements. RT was performed in 188 pediatric recipients during the study period. In the matched cohort, percentage of transfused patients during transplantation in the OvR group was more than double compared with SMR (89% vs 39%, P < .001); similarly, the median number of transfused PRBC units in OvR was 1, while the median of SMR did not receive transfusion (P < .001). The difference between expected (calculated) and observed change in Hb was significantly higher in OvR with a median of 1.9 g/dL compared with SMR with a median of 1.0 g/dL (P = .026). Correspondingly, the calculated median volume taken up by a regular size kidney was significantly higher with 213 mL compared with 313 mL (P = .031) taken up by an oversize graft kidney. Median estimated intraoperative blood loss was significantly higher in OvR than in SMR (6.9 mL/kg, vs 5.3 mL/kg, respectively; P = .04). Median postoperative Hb was similar among groups (10.4 g/dL vs 10.6 g/dL for SMR vs OvR, respectively). Transplantation of an oversized kidney in pediatric RT recipients is associated with a quantifiable higher need for blood transfusion. This may be caused by a higher intraoperative EBL and/or greater blood volume sequestered by the larger renal allograft and requires further evaluation.
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Affiliation(s)
- Rakan I Odeh
- Division of Pediatric Urology, The Hospital for Sick Children and University of Toronto, Toronto, ON, Canada
| | - Martin Sidler
- Division of Pediatric Urology, The Hospital for Sick Children and University of Toronto, Toronto, ON, Canada.,Department of Paediatric Surgery, Great Ormond Street Hospital for Children, London, UK
| | - Teresa Skelton
- Department of Pediatric Anesthesia, The Hospital for Sick Children and University of Toronto, Toronto, ON, Canada
| | - Fadi Zu'bi
- Division of Pediatric Urology, The Hospital for Sick Children and University of Toronto, Toronto, ON, Canada
| | - Naimet K Naoum
- Division of Pediatric Urology, The Hospital for Sick Children and University of Toronto, Toronto, ON, Canada
| | - Ibraheem Abu Azzawayed
- Division of Pediatric Urology, The Hospital for Sick Children and University of Toronto, Toronto, ON, Canada
| | - Fahad A Alyami
- Division of Urology, Department of Surgery, King Saud University, Riyadh, Saudi Arabia
| | - Armando J Lorenzo
- Division of Pediatric Urology, The Hospital for Sick Children and University of Toronto, Toronto, ON, Canada
| | - Walid A Farhat
- Division of Pediatric Urology, The Hospital for Sick Children and University of Toronto, Toronto, ON, Canada
| | - Martin A Koyle
- Division of Pediatric Urology, The Hospital for Sick Children and University of Toronto, Toronto, ON, Canada
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Reusz GS, Molnar MZ. Are kidney transplantation outcomes improved in children weighting 15 kilograms or less in the last decades? Transpl Int 2018; 31:703-705. [PMID: 29341248 DOI: 10.1111/tri.13113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 01/10/2018] [Indexed: 11/28/2022]
Affiliation(s)
- George S Reusz
- First Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Miklos Z Molnar
- Division of Transplant Surgery, Methodist University Hospital Transplant Institute, Memphis, TN, USA.,Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA.,Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA.,Department of Transplantation and Surgery, Semmelweis University, Budapest, Hungary
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Graft Growth and Podocyte Dedifferentiation in Donor-Recipient Size Mismatch Kidney Transplants. Transplant Direct 2017; 3:e210. [PMID: 29026873 PMCID: PMC5627741 DOI: 10.1097/txd.0000000000000728] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Revised: 07/05/2017] [Accepted: 07/22/2017] [Indexed: 12/23/2022] Open
Abstract
Background Kidney transplantation is the treatment choice for patients with end-stage renal diseases. Because of good long-term outcome, pediatric kidney grafts are also accepted for transplantation in adult recipients despite a significant mismatch in body size and age between donor and recipient. These grafts show a remarkable ability of adaptation to the recipient body and increase in size in a very short period, presumably as an adaptation to hyperfiltration. Methods We investigated renal graft growth as well as glomerular proliferation and differentiation markers Kiel-67, paired box gene 2 and Wilms tumor protein (WT1) expression in control biopsies from different transplant constellations: infant donor for infant recipient, infant donor for child recipient, infant donor for adult recipient, child donor for child recipient, child donor for adult recipient, and adult donor for an adult recipient. Results We detected a significant increase in kidney graft size after transplantation in all conditions with a body size mismatch, which was most prominent when an infant donated for a child. Podocyte WT1 expression was comparable in different transplant conditions, whereas a significant increase in WT1 expression could be detected in parietal epithelial cells, when a kidney graft from a child was transplanted into an adult. In kidney grafts that were relatively small for the recipients, we could detect reexpression of podocyte paired box gene 2. Moreover, the proliferation marker Kiel-67 was expressed in glomerular cells in grafts that increased in size after transplantation. Conclusions Kidney grafts rapidly adapt to the recipient size after transplantation if they are transplanted in a body size mismatch constellation. The increase in transplant size is accompanied by an upregulation of proliferation and dedifferentiation markers in podocytes. The different examined conditions exclude hormonal factors as the key trigger for this growth so that most likely hyperfiltration is the key trigger inducing the rapid growth response.
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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.
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Winnicki E, Dharmar M, Tancredi D, Butani L. Comparable Survival of En Bloc versus Standard Donor Kidney Transplants in Children. J Pediatr 2016; 173:169-74. [PMID: 26898807 DOI: 10.1016/j.jpeds.2016.01.054] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2015] [Revised: 12/17/2015] [Accepted: 01/21/2016] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To determine whether renal transplantation survival is similar in children receiving pediatric en bloc kidneys compared with those receiving standard deceased donor kidneys. STUDY DESIGN We compared time to allograft failure and estimated glomerular filtration rate (eGFR) in pediatric recipients of en bloc and standard criteria deceased donor renal transplants using Organ Procurement and Transplantation Network data for 2000-2013. Cox regression analysis was used to compare time to allograft failure, and the Student t test was used to compare eGFR. RESULTS A total of 6882 recipients met the study inclusion criteria; 1.8% received an en bloc transplant. The adjusted hazard for allograft failure was similar for recipients of en bloc kidneys compared with standard criteria kidneys (hazard ratio, 1.15; 95% CI, 0.83-1.59; P = .41). The median wait time for transplantation was significantly shorter for recipients of en bloc kidneys (157 days vs 208 days; P = .03). Moreover, eGFR was superior for recipients of en bloc kidneys up to 5 years post-transplantation. CONCLUSION Transplantation of en bloc pediatric kidneys should be considered a viable option for pediatric recipients and may afford unique benefits by reducing wait times and promoting preservation of graft function.
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Affiliation(s)
- Erica Winnicki
- Department of Pediatrics, University of California Davis, Sacramento, CA.
| | - Madan Dharmar
- Department of Pediatrics, University of California Davis, Sacramento, CA
| | - Daniel Tancredi
- Department of Pediatrics, University of California Davis, Sacramento, CA
| | - Lavjay Butani
- Department of Pediatrics, University of California Davis, Sacramento, CA
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Jalanko H, Mattila I, Holmberg C. Renal transplantation in infants. Pediatr Nephrol 2016; 31:725-35. [PMID: 26115617 DOI: 10.1007/s00467-015-3144-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 05/27/2015] [Accepted: 06/08/2015] [Indexed: 01/28/2023]
Abstract
Renal transplantation (RTx) has become an accepted mode of therapy in infants with severe renal failure. The major indications are structural abnormalities of the urinary tract, congenital nephrotic syndrome, polycystic diseases, and neonatal kidney injury. Assessment of these infants needs expertise and time as well as active treatment before RTx to ensure optimal growth and development, and to avoid complications that could lead to permanent neurological defects. RTx can be performed already in infants weighing around 5 kg, but most operations occur in infants with a weight of 10 kg or more. Perioperative management focuses on adequate perfusion of the allograft and avoidance of thrombotic and other surgical complications. Important long-term issues include rejections, infections, graft function, growth, bone health, metabolic problems, neurocognitive development, adherence to medication, pubertal maturation, and quality of life. The overall outcome of infant RTx has dramatically improved, with long-term patient and graft survivals of over 90 and 80 %, respectively.
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Affiliation(s)
- Hannu Jalanko
- Department Pediatric Nephrology and Transplantation, Children's Hospital, University of Helsinki and Helsinki University Hospital, PO Box 281, Helsinki, 00290, Finland.
| | - Ilkka Mattila
- Department of Cardiac and Transplantation Surgery, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Christer Holmberg
- Department Pediatric Nephrology and Transplantation, Children's Hospital, University of Helsinki and Helsinki University Hospital, PO Box 281, Helsinki, 00290, Finland
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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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Chaudhuri A, Grimm P, Concepcion W. Small pediatric deceased donors for pediatric renal transplant recipients. Pediatr Transplant 2016; 20:7-10. [PMID: 26916965 DOI: 10.1111/petr.12646] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Abanti Chaudhuri
- Department of Pediatric Nephrology, Stanford University, School of Medicine, Stanford, CA, USA.
| | - Paul Grimm
- Department of Pediatric Nephrology, Stanford University, School of Medicine, Stanford, CA, USA
| | - Waldo Concepcion
- Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
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Sui M, Zhao W, Chen Y, Zhu F, Zhu Y, Zeng L, Zhang L. Optimizing the utilization of kidneys from small pediatric deceased donors under 15 kg by choosing pediatric recipients. Pediatr Transplant 2016; 20:39-43. [PMID: 26616462 DOI: 10.1111/petr.12645] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/28/2015] [Indexed: 01/22/2023]
Abstract
Currently, most kidneys from small pediatric deceased donors are transplanted into adult recipients (i.e., PTA). However, due to the weight mismatch, there is a high discard rate and a high ratio of EBKTs if adopting PTA. Here, we sought both to optimize utilization of these challenging but scarce donor grafts by selecting pediatric recipients and to characterize the feasibility and efficacy of this PTP allocation strategy. From February 2012 to October 2014, kidneys from 27 infant donors ≤ 15 kg were procured and distributed to 38 pediatric candidates in our center. The grafts were utilized for EBKT if the donor weighed 2.5-5 kg and for SKT if the donor weighed 5-15 kg, leading to 10 EBKTs and 28 SKTs. The overall utilization rate from small pediatric deceased donors was 94.12%. After a follow-up of 3-26 months, the graft survival rate was 89.47%, with four graft losses due to vascular thrombosis. Kidneys from low-body-weight donors should be applied to pediatric recipients, and the kidneys from infant donors ≥ 5 kg can be used in single-kidney-transplant procedures at experienced centers to optimize utilization.
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Affiliation(s)
- Mingxing Sui
- Organ Transplantation Center, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Wenyu Zhao
- Organ Transplantation Center, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Yu Chen
- Organ Transplantation Institute of PLA, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Fanyuan Zhu
- Organ Transplantation Institute of PLA, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Youhua Zhu
- Organ Transplantation Center, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Li Zeng
- Organ Transplantation Center, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Lei Zhang
- Organ Transplantation Institute of PLA, Changzheng Hospital, Second Military Medical University, Shanghai, China
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La transplantation rénale pédiatrique. MEDECINE INTENSIVE REANIMATION 2014. [DOI: 10.1007/s13546-014-0933-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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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.
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Donor-recipient size mismatch in paediatric renal transplantation. J Transplant 2014; 2014:317574. [PMID: 24688785 PMCID: PMC3943255 DOI: 10.1155/2014/317574] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Accepted: 01/09/2014] [Indexed: 12/25/2022] Open
Abstract
Introduction. End stage renal failure in children is a rare but devastating condition, and kidney transplantation remains the only permanent treatment option. The aim of this review was to elucidate the broad surgical issues surrounding the mismatch in size of adult kidney donors to their paediatric recipients. Methods. A comprehensive literature search was undertaken on PubMed, MEDLINE, and Google Scholar for all relevant scientific articles published to date in English language. Manual search of the bibliographies was also performed to supplement the original search. Results. Size-matching kidneys for transplantation into children is not feasible due to limited organ availability from paediatric donors, resulting in prolonged waiting list times. Transplanting a comparatively large adult kidney into a child may lead to potential challenges related to the surgical incision and approach, vessel anastomoses, wound closure, postoperative cardiovascular stability, and age-correlated maturation of the graft. Conclusion. The transplantation of an adult kidney into a size mismatched paediatric recipient significantly reduces waiting times for surgery; however, it presents further challenges in terms of both the surgical procedure and the post-operative management of the patient's physiological parameters.
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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.
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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.
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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.
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Pape L, Ahlenstiel T, Werner CD, Zapf A. Development and validation of a new statistical model for prognosis of long-term graft function after pediatric kidney transplantation. Pediatr Nephrol 2013; 28:499-505. [PMID: 23131863 DOI: 10.1007/s00467-012-2346-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Revised: 09/24/2012] [Accepted: 09/26/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND No adequate statistical model has been established to estimate future glomerular filtration rate (GFR) in children after kidney transplantation (KTX). Equations based on simple linear regression analysis as used in adults are not established in children. METHODS An optimal prognostic model of GFR was generated for 63 children at 3-7 years after KTX. The main regression model for prediction of the log-transformed GFR (logGFR) included the mean monthly change of GFR in the period 3-24 months after KTX (∆GFR), the baseline GFR at 3 months (bGFR), and an intercept. Additionally, we investigated if the inclusion of cofactors leads to more precise predictions. The model was validated by leave-one-out cross-validation for years 3-7 after KTX. Prognostic quality was determined with the mean squared error (MSE) and mean absolute error (MAE). Results were compared with the simple linear regression model used in adults. RESULTS The following statistical model was calculated for every prognosis year (i = 3, …, 7):[Formula: see text] [Formula: see text] Comparison of the new statistical model and the simple linear model for adults led to relevantly lower MSEs and MAEs for the new model (year 7: New model: MSE 0.1, MAE 0.3/adult model: MSE 1069, MAE 18). The benefit of inclusion of cofactors was not relevant. CONCLUSIONS This statistical model is able to predict long-term graft function in children with very high precision.
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Affiliation(s)
- Lars Pape
- Department of Pediatric Nephrology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany.
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Butani L, Troppmann C, Perez RV. Outcomes of children receiving en bloc renal transplants from small pediatric donors. Pediatr Transplant 2013; 17:55-8. [PMID: 23170991 DOI: 10.1111/petr.12021] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/01/2012] [Indexed: 11/27/2022]
Abstract
The utilization of en bloc renal allografts from small pediatric donors has been adopted as an effective strategy to expand the organ donor pool in adult recipients. Data in children are limited. The aim of our study is to describe the outcomes of en bloc renal transplants in children from our center. Medical records of children receiving pediatric en bloc renal transplants at our institution from January 2007 were abstracted. Data collected included recipient and donor demographics, operative technique and complications, and post-operative studies. Eight children received en bloc renal transplants at a median age of 17 yr; median follow-up was 0.9 yr. Donor body weight ranged from 4 to 22 kg. One kidney was lost to intra-operative thrombosis, while the other kidney from this en bloc graft remained viable. All grafts showed increased renal size at follow-up ultrasound. Surveillance biopsies showed glomerulomegaly in two patients. At last follow-up, the median eGFR was 130 mL/min/1.73 m(2). The urinary protein to creatinine ratio was normal in four of seven patients. Our data suggest that in experienced centers, en bloc renal transplantation from young donors into pediatric recipients is effective. Long-term follow-up to monitor for complications, including hyperfiltration injury, is warranted.
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Affiliation(s)
- Lavjay Butani
- Department of Pediatrics, University of California Davis, Sacramento, CA 95817, USA.
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De Souza VC, Rabilloud M, Cochat P, Selistre L, Hadj-Aissa A, Kassai B, Ranchin B, Berg U, Herthelius M, Dubourg L. Schwartz formula: is one k-coefficient adequate for all children? PLoS One 2012; 7:e53439. [PMID: 23285295 PMCID: PMC3532344 DOI: 10.1371/journal.pone.0053439] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Accepted: 11/28/2012] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND/OBJECTIVE Plasma-creatinine-based equations to estimate the glomerular filtration rate are recommended by several clinical guidelines. In 2009, Schwartz et al. adapted the traditional Schwartz equation to children and adolescents but did not find different k-coefficients between children and adolescents (k = 36.5 for all patients). We reevaluated the coefficient of the 2009-Schwartz formula according to sex and age in a pediatric population. PATIENTS/METHODS We used linear mixed-effects models to reestimate the 2009-Schwartz k-coefficient in 360 consecutive French subjects aged 1 to 18 years referred to a single centre between July 2003 and July 2010 (965 measurements). We assessed the agreement between the estimated glomerular filtration rate obtained with the new formula (called Schwartz-Lyon) and the rate measured by inulin clearance. We then compared this agreement to the one between the measured glomerular filtration rate and 2009-Schwartz formula, first in the French then in a Swedish cohort. RESULTS In Schwartz-Lyon formula, k was estimated at 32.5 in boys <13 years and all girls and at 36.5 in boys aged ≥13 years. The performance of this formula was higher than that of 2009-Schwartz formula in children <13 years. This was first supported by a statistically significant reduction of the overestimation of the measured glomerular filtration rate in both cohorts, by better 10% and 30% accuracies, and by a better concordance correlation coefficient. CONCLUSIONS The performance and simplicity of Schwartz formula are strong arguments for its routine use in children and adolescents. The specific coefficient for children aged <13 years further improves this performance.
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Affiliation(s)
- Vandrea Carla De Souza
- Centre de Référence des Maladies Rénales Rares, Service de Néphrologie et Rhumatologie Pédiatriques, Hospices Civils de Lyon, Lyon, France.
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Naesens M, Salvatierra O, Benfield M, Ettenger R, Dharnidharka V, Harmon W, Mathias R, Sarwal MM. Subclinical inflammation and chronic renal allograft injury in a randomized trial on steroid avoidance in pediatric kidney transplantation. Am J Transplant 2012; 12:2730-43. [PMID: 22694733 PMCID: PMC3459071 DOI: 10.1111/j.1600-6143.2012.04144.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Steroid avoidance is safe and effective in children receiving kidney transplants in terms of graft function and survival, but the effects on allograft histology are unknown. In this multicenter trial, 130 pediatric renal transplant recipients were randomized to steroid-free (SF; n = 60) or steroid-based (SB; n = 70) immunosuppression, and underwent renal allograft biopsies at the time of graft dysfunction and per protocol at implantation and 6, 12 and 24 months after transplantation. Clinical follow-up was 3 years posttransplant. Subclinical acute rejection was present in 10.6% SF versus 11.3% SB biopsies at 6 months (p = 0.91), 0% SF versus 4.3% SB biopsies at 1 year (p = 0.21) and 0% versus 4.8% at 2 years (p = 0.20). Clinical acute rejection was present in 13.3% SF and 11.4% SB patients by 1 year (p = 0.74) and in 16.7% SF and 17.1% SB patients by 3 years (p = 0.94) after transplantation. The cumulative incidence of antibody-mediated rejection was 6.7% in SF and 2.9% in SB by 3 years after transplantation (p = 0.30). There was a significant increase in chronic histological damage over time (p < 0.001), without difference between SF and SB patients. Smaller recipient size and higher donor age were the main risk factors for chronic histological injury in posttransplant biopsies.
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Affiliation(s)
- Maarten Naesens
- Department of Nephrology and Renal Transplantation, University Hospitals Leuven, Belgium, EU
| | | | - Mark Benfield
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Robert Ettenger
- Division of Pediatric Nephrology, Mattel Children’s Hospital UCLA, Los Angeles, CA, USA
| | - Vikas Dharnidharka
- Division of Pediatric Nephrology, University of Florida College of Medicine, Gainesville, FL, USA
| | - William Harmon
- Department of Pediatrics, Harvard Medical School, Children’s Hospital Boston, Boston, MA, USA
| | - Robert Mathias
- Department of Pediatrics, University of California San Francisco Medical Center, San Francisco, CA, USA
| | - Minnie M. Sarwal
- Department of Surgery, Stanford University, CA, USA,California Pacific Medical Center, Sutter Health Care, Fan Francisco, CA, USA,Corresponding author: Minnie M. Sarwal, M.D., FRCP, Ph.D., Director, The BIOMARC Program for Personalized Medicine, Sutter Health Care, Professor, California Pacific Medical Center (CPMC) and CPMC Research Institute, 475 Brannan Street, Ste 220, San Francisco, CA 94107, USA,
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Hill A, Concepcion W. Does the porcine model give us insight as to how can we improve renal transplantation from large donors to small recipients? Pediatr Transplant 2012; 16:520-2. [PMID: 22694083 DOI: 10.1111/j.1399-3046.2012.01724.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Ravlo K, Chhoden T, Søndergaard P, Secher N, Keller AK, Pedersen M, Bibby BM, Jørgensen TM, Møldrup U, Ostraat EØ, Birn H, Nørregaard R, Marcussen N, Leuvenink HG, Jespersen B. Early outcome in renal transplantation from large donors to small and size-matched recipients - a porcine experimental model. Pediatr Transplant 2012; 16:599-606. [PMID: 22584014 DOI: 10.1111/j.1399-3046.2012.01707.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Kidney transplantation from a large donor to a small recipient, as in pediatric transplantation, is associated with an increased risk of thrombosis and DGF. We established a porcine model for renal transplantation from an adult donor to a small or size-matched recipient with a high risk of DGF and studied GFR, RPP using MRI, and markers of kidney injury within 10 h after transplantation. After induction of BD, kidneys were removed from ∼63-kg donors and kept in cold storage for ∼22 h until transplanted into small (∼15 kg, n = 8) or size-matched (n = 8) recipients. A reduction in GFR was observed in small recipients within 60 min after reperfusion. Interestingly, this was associated with a significant reduction in medullary RPP, while there was no significant change in the size-matched recipients. No difference was observed in urinary NGAL excretion between the groups. A significant higher level of HO-1 mRNA was observed in small recipients than in donors and size-matched recipients indicating cortical injury. Improvement in early graft perfusion may be a goal to improve short- and long-term GFR and avoid graft thrombosis in pediatric recipients.
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Affiliation(s)
- Kristian Ravlo
- Department of Nephrology Anaesthesiology, Aarhus University Hospital Institute of Clinical Medicine, The Netherlands
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Ghane Sharbaf F, Bitzan M, Szymanski KM, Bell LE, Gupta I, Tchervenkov J, Capolicchio JP. Native nephrectomy prior to pediatric kidney transplantation: biological and clinical aspects. Pediatr Nephrol 2012; 27:1179-88. [PMID: 22366876 PMCID: PMC3362721 DOI: 10.1007/s00467-012-2115-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2010] [Revised: 01/10/2012] [Accepted: 01/18/2012] [Indexed: 12/30/2022]
Abstract
BACKGROUND Pre-transplant nephrectomy is performed to reduce risks to graft and recipient. The aims of this study were to evaluate (1) indications, surgical approach, and morbidity of native nephrectomy and (2) the effects of kidney removal on clinical and biological parameters. METHODS This study was designed as a single-center retrospective cohort study in which 49 consecutive patients with uni- or bilateral native nephrectomies were identified from a total of 126 consecutive graft recipients in our pediatric kidney transplantation database between 1992 and 2011. Demographic, clinical, and laboratory details were extracted from charts and electronic records, including operation reports and pre- and post-operative clinic notes. RESULTS Of the 49 nephrectomized patients, 47% had anomalies of the kidneys and urinary tract, 22% had cystinosis, 12% had focal segmental glomerulosclerosis, and 6% had congenital nephrotic syndrome. Nephrectomy decisions were based on clinical judgment, taking physiological and psychosocial aspects into consideration. Nephrectomy was performed in patients with polyuria (>2.5 ml/kg/h) and/or large proteinuria (>40 mg/m(2)/h), recurrent urinary tract infection or (rarely) hypertension. Urine output decreased from (median) 3.79 to 2.32 ml/kg/h (-34%), and proteinuria from 157 to 100 mg/m(2)/h (-40%) after unilateral nephrectomy (p=0.005). After bilateral nephrectomy, serum albumin, protein and fibrinogen concentrations normalized in 93, 73, and 55% of nephrectomized patients, respectively. Clinically relevant procedure-related complications (peritoneal laceration, hematoma) occurred in five patients. CONCLUSION In summary, we demonstrate quantitatively that native nephrectomy prior to transplantation improved serum protein levels and anticipated post-transplant fluid intake needs in select children, reducing the risk of graft hypoperfusion and its postulated consequences for graft outcome.
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Affiliation(s)
- Fatemeh Ghane Sharbaf
- Division of Nephrology, Montreal Children’s Hospital and McGill University, 2300, rue Tupper—E222, Montreal, Quebec Canada H3H 1P3
- Department of Pediatrics, Dr. Sheikh Hospital, Mashhad University of Medical Sciences, Mashhad, Islamic Republic of Iran
| | - Martin Bitzan
- Division of Nephrology, Montreal Children’s Hospital and McGill University, 2300, rue Tupper—E222, Montreal, Quebec Canada H3H 1P3
| | - Konrad M. Szymanski
- Division of Urology, Montreal Children’s Hospital and McGill University, Montreal, Quebec Canada
| | - Lorraine E. Bell
- Division of Nephrology, Montreal Children’s Hospital and McGill University, 2300, rue Tupper—E222, Montreal, Quebec Canada H3H 1P3
| | - Indra Gupta
- Division of Nephrology, Montreal Children’s Hospital and McGill University, 2300, rue Tupper—E222, Montreal, Quebec Canada H3H 1P3
| | - Jean Tchervenkov
- Department of Surgery and Multiorgan Transplant Program, Royal Victoria Hospital and McGill University, Montreal, Quebec Canada
| | - John-Paul Capolicchio
- Division of Urology, Montreal Children’s Hospital and McGill University, Montreal, Quebec Canada
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Kidney transplantation from small pediatric donors: does recipient body mass index matter? Transplantation 2012; 93:430-6. [PMID: 22262130 DOI: 10.1097/tp.0b013e318241d57d] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND The influence of recipient body mass index (BMI) on pediatric-donor kidney transplant outcomes is unclear. We aimed to determine graft survival and functional outcomes of pediatric-donor kidneys compared with adult kidneys stratified by recipient BMI group. METHODS Scientific Registry of Transplant Recipients data for recipients from 1996 to 2010 were reviewed. Donors were categorized by transplant type, pediatric single kidney transplant (SKT, n=3712), en bloc kidney transplant (EBK, n=1517), or adult standard criteria donor (SCD, n=66,741). Recipients were stratified by BMI tertiles (<24, 24-29, and >29 kg/m). RESULTS SKT and EBK from donors ≤40 kg conferred similar risks of adjusted death-censored graft survival relative to SCDs regardless of recipient BMI except for EBK transplants in recipients with BMI <24 where the effect was protective (adjusted hazard ratio [aHR] 0.71, 95% confidence interval [CI] 0.56-0.94). SKT from donors ≤20 kg conferred worse death-censored graft survival in recipients with BMI <24 (aHR 1.3, 95% CI 1.0-1.6) and BMI >29 (aHR 1.5, 95% CI 1.1-2.0); however, most of the risk appeared early, and the effect was abrogated with reanalysis conditional on 1-year graft survival. Compared with SCDs, 1-year glomerular filtration rates of SKT from donors ≤20 kg were significantly higher when transplanted into recipients with BMI <24 (P<0.01) and similar in the other BMI groups. CONCLUSION Increasing recipient BMI is not a clear risk factor for outcomes or graft function after transplantation with small pediatric-donor kidneys.
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Soliman SA, Shokeir AA, El-Hefnawy AS, Harraz AM, Kamal MM, Shehab El-Din AB, Ghoneim MA. Vascular and haemorrhagic complications of adult and paediatric live-donor renal transplantation: A single-centre study with a long-term follow-up. Arab J Urol 2012; 10:155-61. [PMID: 26558019 PMCID: PMC4442900 DOI: 10.1016/j.aju.2011.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Revised: 12/04/2011] [Accepted: 12/06/2011] [Indexed: 11/25/2022] Open
Abstract
Objectives To compare the haemorrhagic and vascular complications between paediatric and adult renal transplant recipients with a long-term follow-up. Patients and methods Between March 1976 and December 2006, in all, 1865 live-donor renal transplants were carried out. Patients were stratified according to their ages into two groups; paediatric (⩽18 years; 259) and adult (>18 years; 1606). Variables assessed included incidence, risk factors, management and sequelae of vascular and haemorrhagic complications. The effect of these complications on patient and graft survival was compared. Results Haemorrhage requiring active intervention (percutaneous drainage or surgical exploration) was reported in seven children (2.7%) and 29 adults (1.8%), while thrombotic or stenotic complications were recorded in two children (0.77%) and 19 adults (1.18%; P < 0.05). Female gender, delayed onset of diuresis and acute tubular necrosis were significant predictors of vascular complications on univariate analysis, but none remained significant on multivariate analysis. In adults, vascular complications had a significant negative effect on mean (SD) 10-year graft survival compared to patients with no complications, at 19.8 (7.63)% vs. 55.7 (1.66)% (P = 0.01). Children who developed vascular complications had a significantly higher 5- and 10-year graft survival rate than adults (P = 0.01). Conclusion The incidence of vascular complications is comparable in paediatric and adult transplants. Vascular complications had a significant negative influence on graft survival in adult recipients. Children who developed vascular complications appear to tolerate its effects and have a better graft survival than have adults.
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Abstract
Significant progress has been observed in pediatric renal transplantation over the last 20 years, leading to an increase in graft and patient survival. Mortality is low and is mainly due to infections, neoplasias and complications related to the initial disease. Graft survival is 67% at 10 years. Factors which influence graft survival are: donor type (results are better with a live donor), donor age, recipient age (with 2 periods at risk:<2 years old and teenagers), HLA incompatibilities, and recurrence of the initial disease. Chronic allograft nephropathy (CAN) is the major cause of late graft loss. Poor compliance, especially in teenagers, may lead to late rejections and graft loss. Calcineurin inhibitors nephrotoxicity is in part responsible for the development of CAN, thus treatments and the role of mTOR inhibitors will probably evolve. These different factors are discussed in this article.
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Heidotting NA, Ahlenstiel T, Kreuzer M, Franke D, Pape L. The influence of low donor age, living related donation and pre-emptive transplantation on end-organ damage based on arterial hypertension after paediatric kidney transplantation. Nephrol Dial Transplant 2011; 27:1672-6. [PMID: 21987537 DOI: 10.1093/ndt/gfr549] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND To date, no study has described the pre-transplant and transplant risk factors for end-organ damage based on arterial hypertension in children after kidney transplantation (KTX). METHODS A retrospective chart review was performed of 206 children with KTX between 1991 and 2007. Patients<120 cm were excluded as no validated percentiles for 24-h ambulant blood pressure monitoring (ABPM) exist. Complete data sets were available for 116 patients. Data were recorded at 12, 24 and 36 months post- KTX. We analysed the influence of donor age, age at transplantation, pre-emptive transplantation, living or deceased transplantation and glomerular filtration rate (GFR) on the presence of end-organ damage, ABPM, ABPM standard deviation score and the numbers of anti-hypertensives used. RESULTS Lower donor age and the decade of transplantation were associated with less detection of end-organ damage (P=0.001). A lower need for anti-hypertensive medication (P=0.001) was detected in children who received organs from living donors and from deceased donors with a donor age<35 years and who were transplanted pre-emptively. Low recipient age was the only factor associated with lower ABPM (P=0.001). In our study, the type of immunosuppressive regimen and the GFR had no influence on the blood pressure. CONCLUSIONS It may be speculated that the risk of arterial hypertension and associated end-organ damage in children after KTX could be reduced by using organs from young donors with an advantage for living related and pre-emptive donation.
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Effect of donor and recipient variables on the long-term live-donor renal allograft survival in children. Arab J Urol 2011; 9:85-91. [PMID: 26579274 PMCID: PMC4150562 DOI: 10.1016/j.aju.2011.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2011] [Accepted: 07/06/2011] [Indexed: 11/23/2022] Open
Abstract
Objective We aimed to analyse donor and recipient predictors of graft survival in children who received live-donor renal grafts. Patients and methods The study comprised 273 children who received live-donor renal transplants at our center between March 1976 and October 2010. The follow-up ranged from 6 months to 25 years. Donor variables included donor age, gender, donor/recipient body weight ratio (DR BWR), ABO blood groups, human leukocyte antigen, and DR mismatching. Donor-specific problems, e.g., ischemia time during surgery and number of renal arteries, were included. Recipient variables included recipient age, sex, original kidney disease, ischemia time, acute tubular necrosis (ATN) after transplantation, immunosuppression, number of acute rejection episodes, re-transplantation, and development of hypertension. Results Independent variables with a sustained effect on the 5- and 10-year graft survival on multivariate analysis were: ATN after transplant, number of acute rejections, hypertension, and DR BWR. At the last follow-up, 185 patients (67.8%) had a functioning graft, while 82 (30.0%) had graft failure. Only six patients (0.02%) were lost to follow-up. Conclusion Donor and recipient variables that affect short- and long-term graft survival in children with a live-donor renal allograft are DR BWR, number of acute rejections, ATN and hypertension after transplant. Considering these variables provides a better outcome.
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Moudgil A, Martz K, Stablein DM, Puliyanda DP. Good outcome of kidney transplants in recipients of young donors: a NAPRTCS data analysis. Pediatr Transplant 2011; 15:167-71. [PMID: 21199208 DOI: 10.1111/j.1399-3046.2010.01432.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
NAPRTCS data were analyzed to assess outcome of TX recipients from YDs (<5 yr) in comparison with IDs (6-35 yr) and ODs (36-55 yr). Of 9854 TX in NAPRTCS (1987-2003), 469 were YD. Patient survival (PS) and graft survival (GS) were compared between DD TX after 1995; 81YD, 1324 ID, and 429 OD and eGFR were compared among functioning grafts (YD 31, ID 439, OD 174) at three yr. PS was comparable in all groups; GS at one, two, and three yr in TX of YD (91.1%, 83.8%, 79.7%), ID (93.5%, 89.7%, 83.6%), and OD (92.2%, 87.2%, 82.4%) was comparable. The eGFR in YD was comparable to ID but better than OD (86.5 vs. 79.7 vs. 67.2 mL/min/1.73 m2, p 0.139 and<0.0003). Primary graft non-function was more frequent in TX from YD than ID and OD (3.7% vs. 0.3 and 0.7%, p=0.004); the incidence of vascular thrombosis was similar. The aforementioned data show that pediatric recipients of YD had equivalent patient and graft survival. Although primary graft non-function was higher, eGFR of functioning grafts was comparable to ID. With further improvements in care, kidneys from YD may present a viable option for transplantation.
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Affiliation(s)
- Asha Moudgil
- Nephrology, Children National Medical Center, Washington, DC, USA.
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Goldsmith PJ, Asthana S, Fitzpatrick M, Finlay E, Attia MS, Menon KV, Pollard SG, Ridgway DM, Ahmad N. Transplantation of adult-sized kidneys in low-weight pediatric recipients achieves short-term outcomes comparable to size-matched grafts. Pediatr Transplant 2010; 14:919-24. [PMID: 20840437 DOI: 10.1111/j.1399-3046.2010.01375.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Low-weight pediatric recipients are disadvantaged by scarcity of size-matched donors. ASK have been successfully used for pediatric recipients. We report the results of renal transplantation using ASK in low-weight pediatric recipients and compare outcomes in weight-matched and unmatched donor-recipient pairs. The outcomes of renal transplants using ASK grafts in low-weight (<20 kg) recipients from a single center over a 10-yr period were reviewed. Two groups, comprising recipients of grafts from weight-matched and mismatched donors, were compared. Primary outcome was one-yr graft survival. Secondary outcomes were one- and two-yr calculated eGFR, changes in recipient body weight, perioperative cardiovascular stability, rates of AR and DGF. Twenty-three low-weight recipients were transplanted. Eleven received ASK grafts from high-weight donors and 12 grafts from low-weight donors. One patient in each group had early graft loss. No significant difference was observed in rates of DGF, AR, one-yr graft or patient survival and perioperative cardiovascular parameters. ASK with considerable donor:recipient weight discrepancies can be safely transplanted into small pediatric recipients with comparable outcomes to grafts with less weight discrepancy.
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Affiliation(s)
- P J Goldsmith
- Division of Surgery, Department of Transplant Surgery, St James's University Hospital, Leeds, UK
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A one year prospective comparison of kidney growth and function in children recipients of grafts from children and adults. Transplantation 2010; 90:777-81. [PMID: 20689495 DOI: 10.1097/tp.0b013e3181f009b7] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Renal grafts have demonstrated capacity to adapt to the recipient. The aim of this study was to assess the growth of renal grafts transplanted to children, during the first year posttransplant. METHODS We conducted a 1 year prospective study comparing the growth of renal grafts from children and adults donors transplanted in children, and correlated this growth with graft function. Two groups were studied: (a) group 1-32 children transplanted with pediatric deceased kidneys from donors younger than 16 years and (b) group 2-31 children transplanted with organs from adult living donors. Anthropometric assessment, sonographic measurement of the graft, and serum creatinine at 1 week, 1, 6, and 12 months posttransplantation were performed. RESULTS Children from group 1 presented an 18% increase in graft volume after the sixth month of transplant, whereas in group 2 grafts presented a 14% reduction in volume, mainly during the first month; the variation in renal diameters was not uniform. Children from group 1 presented a glomerular filtration rate (GFR) increase during the follow-up (46-102 mL/min/1.73 m). After 1 year, GFR and graft volume were similar. Growth of individuals from both groups was comparable. CONCLUSIONS In the short term, pediatric kidneys raise volume and GFR, whereas adult kidneys slightly lower volume and GFR when transplanted in children. Taking our and other studies results into consideration, we can hypothesize that in addition to compensatory hypertrophy, pediatric grafts are likely capable of continued somatic growth.
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Successful Transplantation of Single Kidneys From Pediatric Donors Weighing Less Than or Equal to 10 kg Into Standard Weight Adult Recipients. Transplantation 2010; 90:518-22. [DOI: 10.1097/tp.0b013e3181e98d35] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Irtan S, Maisin A, Baudouin V, Nivoche Y, Azoulay R, Jacqz-Aigrain E, El Ghoneimi A, Aigrain Y. Renal transplantation in children: critical analysis of age related surgical complications. Pediatr Transplant 2010; 14:512-9. [PMID: 20070565 DOI: 10.1111/j.1399-3046.2009.01260.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
To determine age-related risk factors of urological and vascular complications. We performed a retrospective analysis of the data of 202 renal transplantations in 193 children between 1989 and 2007 at a single institution. Out of 193 grafts (combined renal and liver grafts were excluded), we observed urological complications in 42 cases (21.7%) leading to graft loss in one case and vascular complications in 27 cases (13.9%) leading to graft loss in seven. The urological complications were VUR (n=25, 12.4%), ureteral stricture (n=10, 5%), anastomotic leak (n=4, 2%), ureteral necrosis (n=2, 1%), and incrustative pyelitis (n=1, 0.5%). Vascular complications were arterial stricture (n=14, 7.2%), arterial thrombosis (n=4, 2%), venous thrombosis (n=2, 1%), and others (n=7). Donors aged less than six yr were a risk factor of vascular complications leading to graft loss (p=0.0001), whereas patients with PUV had more urological complications (p=0.001). Overall patient and graft survival is 93.1% and 84% at five yr, respectively. Surgical complications remain a major cause of graft loss (12%) and morbidity in children's kidney transplantation (38.9%). Young age of donors is the major risk factor of early graft loss as a result of vascular complication. However, donor selection based on age is limited by the shortage of organs.
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Affiliation(s)
- S Irtan
- Paediatric Surgery and Urology, Department of Paediatric Nephrology, Robert Debre Hospital, Paris, France.
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Lau KK, Berg GM, Schjoneman YG, Perez RV, Butani L. Pediatric en bloc kidney transplantation into pediatric recipients. Pediatr Transplant 2010; 14:100-4. [PMID: 19490484 DOI: 10.1111/j.1399-3046.2009.01137.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
As a result of the ongoing shortage in organ supply, en bloc renal transplantation from small donors has become more common for adult recipients with ESRD. However, because of concern for higher complication rates and sub-optimal outcomes, it is not being performed in every center, and data describing its use in pediatric recipients are even more limited. We retrospectively studied three patients who have undergone en bloc renal transplantation at our center. Median age at transplantation was 16.7 yr with a median follow-up of 1.2 yr. Donor age ranged from nine to 49 months with weight ranging from 10 to 22 kg. There were no post-operative thrombotic complications. All grafts showed increased renal size at follow-up by ultrasound. There was no clinical or histological rejection at last follow-up. To the best of our knowledge, this is the first report on the outcomes of en bloc kidney transplantation from pediatric donors into pediatric recipients. Based on our experience, albeit very limited, we feel that en bloc renal transplantation from young donors is an acceptable and safe procedure with low complication rates in pediatric recipients and should be given consideration to minimize wait times on the wait list and to improve quality of life.
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Affiliation(s)
- Keith K Lau
- Department of Pediatrics, University of California, Davis, CA 95817, USA.
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Giuliani S, Gamba PG, Chokshi NK, Gasparella P, Murer L, Zanon GF. The effect of donor/recipient body surface area ratio on outcomes in pediatric kidney transplantation. Pediatr Transplant 2009; 13:290-9. [PMID: 19067925 DOI: 10.1111/j.1399-3046.2008.01034.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In pediatric kidney transplantation, the effect of inadequate nephron dosing on graft survival remains undetermined. The aim of this study was to assess the use of D/R BSA, as a reliable indicator of adequate nephron dosing, and eventually a tool to optimize pediatric graft allocation. Following Institutional Review Board approval, we reviewed deceased donor pediatric kidney transplantation (N = 156). We divided patients into three groups, based on D/R BSA: A < or =0.8; B 0.81-1.19; C > or =1.2. Five-yr graft survival rates in the groups were: A 82.0%; B 94.9%; C 97.1% (p = 0.01). Group C had the lowest rate of acute rejection, suggesting a protective effect of increased D/R BSA (group A = 35.7%, group B = 38.9%, group C = 18.8%; p = 0.029). The logistic regression analysis showed that decreased D/R BSA ratio is a risk factor for loss of graft function, at one and five yr [i.e., group A OR 6 (95% CI 1.14-39.30, p = 0.015) and OR 4.49 (95% CI 1.46-13.79, p = 0.009), respectively]. We conclude that for pediatric recipients, D/R BSA is a valuable adjunct when determining long-term graft survival. Its utility may avoid an alloimmune-independent risk factor, increasing the long-term protective value of a good matching policy.
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Affiliation(s)
- Stefano Giuliani
- Division of Pediatric Surgery, Department of Pediatrics, University of Padova, Padova, Italy.
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