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Koch M, Kraus D, Boedecker-Lips S, Mittler J, Tieken I, Weinmann-Menke J. Successful transplantation of four kidney grafts from two small pediatric donors with anuric acute renal failure into adult recipients. Pediatr Transplant 2023; 27:e14542. [PMID: 37194409 DOI: 10.1111/petr.14542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 04/26/2023] [Accepted: 05/03/2023] [Indexed: 05/18/2023]
Abstract
BACKGROUND Kidneys from infants with anuric acute kidney injury (AKI) only rarely get accepted for transplantation despite encouraging data that such kidneys can have very good long-term outcome. METHODS We report the transplantation of four kidney grafts from two pediatric donors (3 and 4 years) with anuric acute kidney injury as single kidneys into four adult recipients. RESULTS All grafts gained function within 14 days posttransplantation, only one recipient needed dialysis after transplantation. None of the recipients suffered from surgical complications. One month after transplantation, all recipients were free of dialysis. Estimated glomerular filtration rates (eGFR) 3 months after transplantation were 37, 40, 50, and 83 mL/min/1.73 m2 . eGFR increased further through month 6, reaching 45, 50, 58, and 89 mL/min/1.73 m2 . CONCLUSION These cases highlight the feasibility of successful transplantation of single pediatric kidney grafts into adult recipients despite anuric AKI of the donor.
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Affiliation(s)
- Martina Koch
- Universitätsmedizin Mainz, Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Mainz, Germany
| | - Daniel Kraus
- Universitätsmedizin Mainz, 1. Medizinische Klinik, Nephrologie, Mainz, Germany
| | | | - Jens Mittler
- Universitätsmedizin Mainz, Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Mainz, Germany
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2
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Seizilles de Mazancourt E, Badet L, Codas Duarte R, Morelon E, Crouzet S, Terrier N, Matillon X. En Bloc Kidney Transplantation: A Retrospective Study of an 18-year Experience in a Single Institution. EUR UROL SUPPL 2022; 46:137-144. [PMID: 36506250 PMCID: PMC9732470 DOI: 10.1016/j.euros.2022.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2022] [Indexed: 11/17/2022] Open
Abstract
Background Renal transplantation is facing a shortage of grafts. En bloc kidney transplantation (EBKT) from pediatric donors could increase the number of available grafts. Objective To describe the surgical technique as well as the long-term functional and morphological results of EBKT. Design setting and participants We performed a retrospective study of all the EBKT procedures performed in Lyon between 2002 and 2020. Electronic medical records were checked with an analysis of demographics, and peri- and postoperative results. Outcome measurements and statistical analysis A descriptive analysis of donor and recipient characteristics, perioperative data, complications, and renal function was performed. Results and limitations Between 2002 and 2020, 21 EBKT procedures were performed. Donors had a mean weight of 8.6 kg and a mean age of 12 mo, with a mean cold ischemia time of 11 h and 30 min. Receivers had a mean age of 30 yr and a body mass index of 20. The mean follow-up time was 62 mo, with patient survival of 100% and graft survival of 95%. There were 13 reinterventions comprising one early unilateral transplantectomy for thrombosis. Renal function was excellent, and the morphological findings described an important growth in size in the first 2 yr before attaining the adult size. This study's limitations include its retrospective nature and a small number of participants. Conclusions The present study reports excellent results with EBKT and supports the pursuit and spread of this technique. Patient summary In this report, we describe the technique and results of en bloc kidney transplantation. We found that results are excellent for renal function and patient survival. We conclude that en bloc kidney transplantation should be considered to increase the number of grafts.
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Affiliation(s)
- Emilien Seizilles de Mazancourt
- Department of Urology Surgery and Transplantation, Edouard Herriot Hospital, Lyon, France,Corresponding author. Department of Urology Surgery and Transplantation, Edouard Herriot Hospital, Lyon, France. Tel. +33662431639.
| | - Lionel Badet
- Department of Urology Surgery and Transplantation, Edouard Herriot Hospital, Lyon, France
| | - Ricardo Codas Duarte
- Department of Urology Surgery and Transplantation, Edouard Herriot Hospital, Lyon, France
| | - Emmanuel Morelon
- Department of Transplantation, Nephrology and Immunology, Hospices Civils de Lyon, Lyon, France
| | - Sebastien Crouzet
- Department of Urology Surgery and Transplantation, Edouard Herriot Hospital, Lyon, France
| | | | - Xavier Matillon
- Department of Urology Surgery and Transplantation, Edouard Herriot Hospital, Lyon, France
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Troppmann C, Santhanakrishnan C, Fananapazir G, Sageshima J, Troppmann KM, Perez RV. Short- and Long-term Outcomes of Kidney Transplants From Very Small (≤15 kg) Pediatric Donors With Acute Kidney Injury. Transplantation 2021; 105:430-435. [PMID: 32217942 DOI: 10.1097/tp.0000000000003230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Kidneys from small deceased pediatric donors with acute kidney injury (AKI) are commonly discarded owing to transplant centers' concerns regarding potentially inferior short- and long-term posttransplant outcomes. METHODS We retrospectively analyzed our center's en bloc kidney transplants performed from November 2007 to January 2015 from donors ≤15 kg into adult recipients (≥18 y). We pair-matched grafts from 27 consecutive donors with AKI versus 27 without AKI for donor weight, donation after circulatory death status, and preservation time. RESULTS For AKI versus non-AKI donors, median weight was 7.5 versus 7.1 kg; terminal creatinine was 1.7 (range, 1.1-3.3) versus 0.3 mg/dL (0.1-0.9). Early graft loss rate from thrombosis or primary nonfunction was 11% for both groups. Delayed graft function rate was higher for AKI (52%) versus non-AKI (15%) grafts (P = 0.004). Median estimated glomerular filtration rate was lower for AKI recipients only at 1 and 3 months (P < 0.03). Graft survival (death-censored) at 8 years was 78% for AKI versus 77% for non-AKI grafts. Late proteinuria rates for AKI versus non-AKI recipients with >4 years follow-up were not significantly different. CONCLUSIONS Small pediatric donor AKI impacted early posttransplant kidney graft function, but did not increase risk for early graft loss and decreased long-term function. The presently high nonutilization rates for en bloc kidney grafts from very small pediatric donors with AKI appear therefore unjustified. Based on the outcomes of the present study, we infer that the reluctance to transplant single kidneys from larger pediatric donors with AKI lacks a rational basis as well. Our findings warrant further prospective study and confirmation in larger study cohorts.
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Affiliation(s)
- Christoph Troppmann
- Department of Surgery, University of California, Davis School of Medicine, Sacramento, CA
| | | | - Ghaneh Fananapazir
- Department of Radiology, University of California, Davis School of Medicine, Sacramento, CA
| | - Junichiro Sageshima
- Department of Surgery, University of California, Davis School of Medicine, Sacramento, CA
| | - Kathrin M Troppmann
- Department of Surgery, University of California, Davis School of Medicine, Sacramento, CA
| | - Richard V Perez
- Department of Surgery, University of California, Davis School of Medicine, Sacramento, CA
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Jin X, Hu JM, Liu YG, Zhao M. A Multicenter Clinical Study of Single-Kidney Transplantation vs En Bloc Transplantation with Kidneys from Deceased Pediatric Donors. Transplant Proc 2019; 51:3252-3258. [PMID: 31732202 DOI: 10.1016/j.transproceed.2019.06.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 05/08/2019] [Accepted: 06/05/2019] [Indexed: 01/02/2023]
Abstract
BACKGROUND There are still disputes regarding the choice of surgical approach to harvest organs from pediatric donors for organ recipients. The primary goal of this multicenter, retrospective analysis was to compare outcomes between single-kidney transplantation (SKT) and en bloc kidney transplantation (EBKT). METHODS Data from donors and recipients aged 4 to 18 months from 3 transplant centers over 5 year were collected to compare postoperative complications and recoveries of renal function between SKT and EBKT and to determine whether there is a difference in the 1-year patient and kidney survival rate between the 2 groups. RESULTS Between the SKT and EBKT groups, the incidence of delayed graft function was significantly higher in the SKT group than in the EBKT group (44.1% vs 17.3%, P = .03), and there were no significant differences in other complications (47.0% vs 59.0%, P = .36). Moreover, no significant differences were observed for the overall patient survival rate (P = .08) or the overall graft survival rate (P = .71). CONCLUSIONS The short-term effects of SKT make it worthy of consideration. For infants aged 4 to 18 months, SKT can provide good results, alleviating the current tense situation in kidney donation.
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Affiliation(s)
- Xiao Jin
- DongGuan People's Hospital, Dongguan, China; Guangzhou Key Laboratory of Inflammatory and Immune Diseases, Organ Transplantation Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Jian Min Hu
- Guangzhou Key Laboratory of Inflammatory and Immune Diseases, Organ Transplantation Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Yong Guang Liu
- Guangzhou Key Laboratory of Inflammatory and Immune Diseases, Organ Transplantation Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Ming Zhao
- Guangzhou Key Laboratory of Inflammatory and Immune Diseases, Organ Transplantation Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China.
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5
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The Outcomes of Pancreatic Transplantation from Pediatric Donors-A Single Institution Experience. J Clin Med 2019; 8:jcm8091386. [PMID: 31487959 PMCID: PMC6780964 DOI: 10.3390/jcm8091386] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 08/30/2019] [Accepted: 09/02/2019] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES The aim of this study was to compare the outcomes of pancreatic transplantation from pediatric donors younger than 15 years of age to the outcomes of pancreatic transplantation from adult donors. METHODS Sixty patients underwent pancreatic transplantation in our facility from August 2012 to June 2019. These patients were divided into two groups according to the age of the donor: Cases in which the donor was younger than 15 years of age were classified into the PD group (n = 7), while those in which the donor was older than 15 years of age were classified into the AD group (n = 53). The outcomes of pancreas transplantation were retrospectively compared between the two groups. RESULTS Pancreatic graft survival did not differ between the PD and AD groups. Furthermore, there were no differences in the HbA1c and serum creatinine levels at three months, with good values maintained in both groups. The results of oral glucose tolerance tests (OGTTs) revealed that the blood glucose concentration did not differ between the two groups. However, the serum insulin concentration at 30 min after 75 g glucose loading was significantly higher in the PD group. CONCLUSION The outcomes of pancreatic transplantation from pediatric donors may be comparable to those of pancreatic transplantation from adult donors and the insulin secretion ability after transplantation may be better.
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6
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Utilisation of small paediatric donor kidneys for transplantation. Pediatr Nephrol 2019; 34:1717-1726. [PMID: 30238149 PMCID: PMC6775037 DOI: 10.1007/s00467-018-4073-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 08/22/2018] [Accepted: 08/28/2018] [Indexed: 11/14/2022]
Abstract
With the increasing need for kidney transplantation in the paediatric population and changing donor demographics, children without a living donor option will potentially be offered an adult deceased donor transplant of marginal quality. Given the importance of long-term graft survival for paediatric recipients, consideration is now being given to kidneys from small paediatric donors (SPDs). There exist a lack of consensus and a reluctance amongst some centres in transplanting SPDs due to high surgical complication rates, graft loss and concerns regarding low nephron mass and long-term function. The aim of this review is to examine and present the evidence base regarding the transplantation of these organs. The literature in both the paediatric and adult renal transplant fields, as well as recent relevant conference proceedings, is reviewed. We discuss the surgical techniques, long-term graft function and rates of complications following transplantation of SPDs. We compare graft survival of SPDs to adult deceased donors and consider the use of small paediatric donors after circulatory death (DCD) organs. In conclusion, evidence is presented that may refute historically held paradigms regarding the transplantation of SPDs in paediatric recipients, thereby potentially allowing significant expansion of the donor pool.
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Troppmann C, Santhanakrishnan C, Fananapazir G, Troppmann K, Perez R. Pediatric en bloc kidney transplantation from very small (≤10 kg) donation after circulatory death (versus brain death) donors: Single-center matched-pair analysis of 130 transplants. Am J Transplant 2018; 18:2811-2817. [PMID: 29722133 DOI: 10.1111/ajt.14914] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 03/23/2018] [Accepted: 04/15/2018] [Indexed: 01/25/2023]
Abstract
En bloc kidney transplants (EBK) from very small pediatric donation after circulatory death (DCD) donors are infrequent because of the perception that DCD adversely impacts outcomes. We retrospectively studied 130 EBKs from donors ≤10 kg (65 consecutive DCD vs 65 donation after brain death [DBD] transplants; pair-matched for donor weight and terminal creatinine, and for preservation time). For DCD vs DBD, median donor weight was 5.0 vs 5.0 kg; median recipient age was 57 vs 48 years (P = .006). Graft losses from thrombosis (DCD, 5%; DBD, 7%) or primary nonfunction (DCD, 3%; DBD, 0%) were similar in both groups (P = .7). Delayed graft function rate was higher for DCD (25%) vs DBD (14%) (P = .2). Graft survival (death-censored) for DCD vs DBD at 5 years was 87% vs 91% (P = .3). Median estimated GFR (mL/min per 1.73 m2 ) was significantly lower for DCD recipients at 1 and 3 months; at 6 years it remained stable at 100 (DCD) and 99 (DBD). DCD impacted early posttransplant graft function, but did not appear to impart added risk for graft loss and long-term function. Very small (≤10 kg) DCD EBK donors should be considered as an option to augment the deceased kidney donor pool; larger studies with longer follow-up must confirm these findings.
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Affiliation(s)
- Christoph Troppmann
- Department of Surgery, University of California, Davis, School of Medicine, Sacramento, CA, USA
| | | | - Ghaneh Fananapazir
- Department of Radiology, University of California, Davis, School of Medicine, Sacramento, CA, USA
| | - Kathrin Troppmann
- Department of Surgery, University of California, Davis, School of Medicine, Sacramento, CA, USA
| | - Richard Perez
- Department of Surgery, University of California, Davis, School of Medicine, Sacramento, CA, USA
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Dai H, Peng L, Peng F, Lan G, Wang Y, Chen J, Liu L, Gao C, Guo Y, Fang C, Nie M, Long W, Yu S. A novel technique for en bloc kidney transplantation from infant donors with extremely low body weight by using the distal abdominal aorta as an outflow tract. Am J Transplant 2018; 18:2200-2207. [PMID: 29446251 DOI: 10.1111/ajt.14692] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 02/04/2018] [Accepted: 02/06/2018] [Indexed: 01/25/2023]
Abstract
Pediatric kidney donors remain underutilized due to the high risk of postoperative thrombosis. To address this problem, we developed a novel en bloc kidney transplantation technique using donor thoracic aorta and the distal abdominal aorta as inflow and outflow tracts, respectively. Briefly, eight kidneys from deceased infant donors under five months old and with low body weight (1.9-4.9 kg) were transplanted en bloc into four pediatric and four adult patients. The donor's common iliac artery or external iliac artery was anastomosed to the recipient's distal external iliac artery or inferior epigastric artery, respectively, as an outflow tract. Recipients received basiliximab or antithymocyte globulin as induction therapy followed by tacrolimus, mycophenolate mofetil, and prednisone but without prophylactic anticoagulation. Delayed graft function was observed in one patient but was reversed at 90 days posttransplant. Two patients had urine leakage, which was cured by conservative treatment. Two recipients developed lung infections that eventually cleared. No patients experienced posttransplant vascular thrombosis. After 1-1.5 years of follow-up, all patients are well and have normal serum creatinine levels. In conclusion, this novel en bloc kidney transplantation technique using a modified arterial inflow and outflow tract can prevent vascular thrombosis and provide adequate graft function.
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Affiliation(s)
- Helong Dai
- Department of Urological Organ Transplantation, Center of Organ Transplantation, The Second Xiangya Hospital of Central South University, Changsha, China.,Department of Surgery, Starzl Transplantation Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Longkai Peng
- Department of Urological Organ Transplantation, Center of Organ Transplantation, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Fenghua Peng
- Department of Urological Organ Transplantation, Center of Organ Transplantation, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Gongbin Lan
- Department of Urological Organ Transplantation, Center of Organ Transplantation, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Yu Wang
- Department of Urological Organ Transplantation, Center of Organ Transplantation, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Jingjing Chen
- Department of Urological Organ Transplantation, Center of Organ Transplantation, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Lei Liu
- Department of Urological Organ Transplantation, Center of Organ Transplantation, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Chen Gao
- Department of Urological Organ Transplantation, Center of Organ Transplantation, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Yong Guo
- Department of Urological Organ Transplantation, Center of Organ Transplantation, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Chunhua Fang
- Department of Urological Organ Transplantation, Center of Organ Transplantation, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Manhua Nie
- Department of Urological Organ Transplantation, Center of Organ Transplantation, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Wang Long
- Department of Urological Organ Transplantation, Center of Organ Transplantation, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Shaojie Yu
- Department of Urological Organ Transplantation, Center of Organ Transplantation, The Second Xiangya Hospital of Central South University, Changsha, China
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9
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Wang HY, Li J, Liu LS, Deng RH, Fu Q, Ko DSC, Zhang HX, Deng SX, Wang CX. En bloc kidney transplantation from infant donors younger than 10 months into pediatric recipients. Pediatr Transplant 2017; 21. [PMID: 28042690 DOI: 10.1111/petr.12845] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/19/2016] [Indexed: 11/29/2022]
Abstract
Early graft loss and poor graft function limit the use of kidneys from infant donors. Six en bloc kidney transplantations were performed from infant donors younger than 10 months into pediatric recipients between November 2012 and September 2015 at our center. We retrospectively analyzed recipient and donor demographics, surgery procedures, complications, graft function and size, and patient and graft survival with a follow-up of 6-39 months (median 15.5 months). Donor age ranged from 1 to 10 months with weight ranging from 3.5 to 10 kg. Recipient age ranged from 10 to 16 years with weight ranging from 30 to 39 kg. One kidney was removed due to arterial thrombosis during surgery, while the other kidney of this en bloc graft remained viable. Urine leak followed by bilateral ureteral obstruction occurred in one recipient. All of the recipients showed immediate graft function. The size of the en bloc kidney increased from 4.2±0.6 cm to 7.6±0.6 cm 6 months after surgery. Patient and graft survival were both 100% at the last follow-up. Our results show that en bloc kidney transplantation from infant donors younger than 10 months into pediatric recipients is effective under the condition of experienced surgical techniques and perioperative management.
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Affiliation(s)
- Hong-Yang Wang
- Organ Transplantation Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jun Li
- Organ Transplantation Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Long-Shan Liu
- Organ Transplantation Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Rong-Hai Deng
- Organ Transplantation Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Qian Fu
- Organ Transplantation Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Dicken Shiu-Chung Ko
- Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Huan-Xi Zhang
- Organ Transplantation Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Su-Xiong Deng
- Organ Transplantation Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Chang-Xi Wang
- Organ Transplantation Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory on Organ Donation and Transplant Immunology, Guangzhou, China
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10
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Li JF, Liu J, Guo T, Pang XL, Liu L, Feng YH, Wang ZG, Feng GW, Shang WJ. Kidney transplantation from pediatric donors in a single Chinese center. Cell Biochem Biophys 2015; 70:1713-7. [PMID: 24973957 DOI: 10.1007/s12013-014-0118-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
To report clinical outcomes of kidney transplantation from pediatric brain and cardiac death donors (DBCD) in a single Chinese center and to investigate its feasibility to expand organ donor pool. 18 recipients, transplanted between August 2011 and October 2013 in the First Affiliated Hospital of Zhengzhou University, receive a single graft from DBCD donors age ranged from 1.5 to 13 years old. Renal function expressed as serum creatinine, blood urea nitrogen as well as eGFR values at 1, 2 weeks as well as 1-, 3-, 6-, and 12-months post-transplantation was evaluated. Graft size was also monitored at the same time by ultrasonography. In addition, delayed graft function, acute rejection, surgical complication as well as patient and graft survival were also assessed. The primary causes of DBCD donors included six cases of severe brain trauma and three cases of cerebral hemorrhage. The mean age of DBCD donors was (7.2 ± 3.4) years (range 1.5-13). The mean weight of DBCD donors was (29.8 ± 15.3) kilogram (range 13-67). The mean height of DBCD donors was (118.3 ± 27.8) centimeter (range 70-173). ECMO was applied to DBCD donors to avoid warm ischemia time and the applicating time was (79.8 ± 44.5) (range 32-180) minutes.There were seven males and 11 females recipients. Among which, 16 recipients were pediatrics and two recipients were adults. The mean age of the recipients was (14.6 ± 9.7) years (range 4-47). The mean weight of recipients was (31.9 ± 12.4) kilogram (range 11-54). The mean height of recipients was (138.0 ± 23.7) centimeter (range 84-172). Renal function recovered to normal within the first-week post-operation except one recipient which occurred acute rejection. Two cases of renal artery stenosis were found 2-week and 3-month post-transplantation, respectively. They subsequently underwent ballon angioplasty and followed up for 8 and 12 months, respectively, and no recurrence was found. One recipient developed ureteral leak. Five weeks later, the ureter leak healed after adequate drainage and prolongation of indwelling catheter. Graft size significantly and continuously increased during the first year, especially in the first 3-month post-transplantation. All the 18 recipients are alive at the last follow-up. Among which, 16 recipients are followed up for 12 months and 1-year recipient/graft survival rate is 100 %. The use of single kidney graft from pediatric DBCD could yield good short-term results.
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Affiliation(s)
- Jin-feng Li
- Kidney Transplantation Unit, Key-Disciplines Laboratory Clinical-Medicine Henan, The First Affiliated Hospital of Zhengzhou University, 1 Construction Road, Zhengzhou, 450052, People's Republic China
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11
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Dion M, Rowe N, Shum J, Weernink C, Felbel S, McAlister VC, Sener A, Luke PP. Donation after Cardiac Death Pediatric En Bloc Renal Transplantation. J Urol 2015; 193:281-5. [DOI: 10.1016/j.juro.2014.07.089] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2014] [Indexed: 11/25/2022]
Affiliation(s)
- Marie Dion
- Department of Surgery, Division of Urology, Western University, London, Ontario, Canada
| | - Neal Rowe
- Department of Surgery, Division of Urology, Western University, London, Ontario, Canada
- Multi-Organ Transplant Program, London Health Sciences Center, London, Ontario, Canada
| | - Jeffrey Shum
- Department of General Surgery, Western University, London, Ontario, Canada
- Multi-Organ Transplant Program, London Health Sciences Center, London, Ontario, Canada
| | - Corinne Weernink
- Multi-Organ Transplant Program, London Health Sciences Center, London, Ontario, Canada
| | - Sarah Felbel
- Department of Surgery, Division of Urology, Western University, London, Ontario, Canada
- Multi-Organ Transplant Program, London Health Sciences Center, London, Ontario, Canada
| | - Vivian C. McAlister
- Department of General Surgery, Western University, London, Ontario, Canada
- Multi-Organ Transplant Program, London Health Sciences Center, London, Ontario, Canada
| | - Alp Sener
- Department of Surgery, Division of Urology, Western University, London, Ontario, Canada
- Multi-Organ Transplant Program, London Health Sciences Center, London, Ontario, Canada
| | - Patrick P. Luke
- Department of Surgery, Division of Urology, Western University, London, Ontario, Canada
- Multi-Organ Transplant Program, London Health Sciences Center, London, Ontario, Canada
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12
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Maluf DG, Carrico RJ, Rosendale JD, Perez RV, Feng S. Optimizing recovery, utilization and transplantation outcomes for kidneys from small, ≤20 kg, pediatric donors. Am J Transplant 2013; 13:2703-12. [PMID: 24010942 DOI: 10.1111/ajt.12410] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2012] [Revised: 05/31/2013] [Accepted: 06/23/2013] [Indexed: 01/25/2023]
Abstract
The optimal balance between maximizing the number versus the outcome of transplantation utilizing kidneys from small (≤20 kg) pediatric donors remains unclear, complicated by the choice of single versus en bloc transplantation with their attendant technical risks. Using the Organ Procurement and Transplantation Network (OPTN) database, we examined kidney recovery and utilization patterns, and 1-year transplant outcomes by single kilogram weight strata. Between January 1, 2005 and June 30, 2010, 2352 kidneys from ≤20 kg donors were transplanted into 1531 recipients, 710 single kidney transplants (SKTs) and 821 en bloc kidney transplants (EBKTs). Increased donor weight was associated with higher rates of recovery, transplantation and SKT. Low donor weight (linear p < 0.001; quadratic p = 0.003), SKT versus EBKT (p = 0.008), increased cold ischemia time (p = 0.003), local versus nonlocal donor (p = 0.0044), low versus high volume center (p = 0.003) and the interaction term between center volume and donor weight (p = 0.0024) were associated with graft failure. Notably, lower donor weight exacerbated the negative impact of low center volume but did not worsen the negative impact of SKT on outcomes. Our data show that EBKT offers superior 1-year survival at the expense of accomplishing one rather than two transplants. However, SKTs yield excellent outcomes when performed at experienced centers.
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Affiliation(s)
- D G Maluf
- Transplant Division, Department of Surgery, University of Virginia, Charlottesville, VA
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13
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Are we ready to expand donation after cardiac death to the newborn population? J Pediatr 2011; 158:6-8. [PMID: 20869726 DOI: 10.1016/j.jpeds.2010.08.037] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2010] [Accepted: 08/25/2010] [Indexed: 11/20/2022]
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Abstract
BACKGROUND To optimize available organs, kidneys from young donors traditionally believed to be suboptimal are transplanted to adults. The purpose of this study is to compare graft survival (GS) of en bloc kidney (EBK) from young pediatric donors to other deceased donor transplants in adult recipients. METHODS We analyzed United Network of Organ Sharing/STAR data on primary deceased donor kidney transplants to adult recipients (1988-2006). EBK (age younger than 5 years, n=1696) was compared with solitary pediatric (SP; age younger than 5 years) kidneys (n=1502), and matched standard adult donors (age 18-59 years, n=9594) and expanded criteria donor (ECD; n=6396). The adjusted GS was obtained using Cox proportional hazard model and hazard ratios were calculated. RESULTS EBK had lowest acute rejection rates (6.0%) but similar to standard adult transplants (6.3%), and lower than SP and ECD (9.0% and 8.2%; P<0.0001). Delayed graft function rates were lowest in EBK (17.9%), highest in ECD (34.8%; P<0.0001), and similar among SP and standard adult transplants (24.4% and 24.2%). The estimated glomerular filtration rate (eGFR) was best in EBK and worst in ECD (P<0.0001). The eGFR of EBK and SP transplants continuously improved but the eGFR of standard adult and ECD declined. Graft loss was higher in EBK and SP transplants than adult donor transplants during the first 6 months. Despite the highest thrombosis rates in EBK (5.0%) (SP, 3.3%; standard adult, 1.8%; ECD, 2.0%, P<0.0001), GS of EBK became similar to standard adult donor transplants by 5 years and best at 10 years posttransplant (64.0%) and worst in ECD (39.6%; P<0.0001). CONCLUSION EBK had the best long-term outcomes among deceased donor transplants and offer unique options for adult kidney transplant recipients.
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Hypothermic Pulsatile Perfusion of Small Pediatric en Bloc Kidneys: Technical Aspects and Outcomes. Transplantation 2009; 88:289-90. [DOI: 10.1097/tp.0b013e3181acc8b3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Farid SG, Goldsmith PJ, Fisher J, Feather S, Finlay E, Attia M, Ahmad N. Successful outcome of paediatricen blockidney transplantation from the youngest donation-after-cardiac-death donor in the United Kingdom. Transpl Int 2009; 22:761-2. [DOI: 10.1111/j.1432-2277.2009.00848.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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