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Reyad A, Reddy NA, Meeks D, Pittman J, Zanville N, Curtis A, Madhrira M, Allam SR. Outcomes of Transplantation of Single Kidneys From Pediatric Donors Into Adult Recipients. Cureus 2024; 16:e52399. [PMID: 38361694 PMCID: PMC10869164 DOI: 10.7759/cureus.52399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2024] [Indexed: 02/17/2024] Open
Abstract
Background Organs from extreme ages have been sought after to help increase the donor pool and alleviate transplantation wait times. There has been a growing evolution of the use of pediatric donor kidneys, including the use of en bloc kidneys (EBK), to now separating them into single kidneys (SKT), allowing for transplantation of two recipients. This study reports our outcomes utilizing SKT. Methods A retrospective review of all SKT performed from 2014 to 2022 at our center was conducted. Donors >8 years of age or >25 kg in weight were excluded. Donor and recipient characteristics and outcomes were analyzed, comparing <18 kg and ≥18 kg donor cohorts. Results Between 2014 and 2022, 81 adults received SKT. Recipients' mean age, weight, and body mass index were 49 years (22-74), 74 kg (39-136), and 26.4 mg/m2 (19.6- 39.8), respectively. Donors' mean age, weight, and kidney size were 35.7 months (8-96), 17.8 kg (8-25), and 7.2 cm (4.5-8.5), respectively. At one year post-transplant, patient survival was 100%, graft survival was 98.7%, mean serum creatinine was 1.25 mg/dL, and mean glomerular filtration rate (GFR) was 68.3 ml/min. Hyperfiltration injury was seen in 43.75% of recipients. None of the outcomes correlated with any of the donor or recipient characteristics. Conclusion Our study shows excellent short-term outcomes of single pediatric kidney transplantation in adult recipients. Exploring a lower donor weight cut-off for SKT, compared to the current Organ Procurement and Transplantation Network's (OPTN's) ≥18 kg, could expand the organ pool and lead to an increased number of transplants.
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Affiliation(s)
- Ashraf Reyad
- Transplant Institute, Medical City Fort Worth, Fort Worth, USA
- Surgery, Burnett School of Medicine at TCU (Texas Christian University), Fort Worth, USA
| | - Nikhil A Reddy
- North Texas Division, HCA Healthcare Research Institute, Fort Worth, USA
| | - Debra Meeks
- Transplant Institute, Medical City Fort Worth, Fort Worth, USA
| | - James Pittman
- Clinical Operations Group, HCA Healthcare, Nashville, USA
| | - Noah Zanville
- Clinical Services Group, HCA Healthcare, Nashville, USA
| | - Anna Curtis
- Transplant Institute, Medical City Fort Worth, Fort Worth, USA
| | - Machaiah Madhrira
- Transplant Nephrology, PPG Health, Fort Worth, USA
- Internal Medicine, Burnett School of Medicine at TCU (Texas Christian University), Fort Worth, USA
- Transplant Institute, Medical City Fort Worth, Fort Worth, USA
| | - Sridhar R Allam
- Transplant Nephrology, PPG Health, Fort Worth, USA
- Internal Medicine, Burnett School of Medicine at TCU (Texas Christian University), Fort Worth, USA
- Transplant Institute, Medical City Fort Worth, Fort Worth, USA
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Huang M, Wu W, Zhang Q, Li J, Zhang H, Wu C, Fu Q, Wu S, Chen Y, Li J, Su X, Liu L, Wang C. Single kidney transplantation from pediatric deceased donors in China: the outcomes and risk factors of graft survival. Transl Pediatr 2022; 11:1872-1885. [PMID: 36506765 PMCID: PMC9732603 DOI: 10.21037/tp-22-547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 11/21/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Pediatric deceased donors offer great potential for expanding the organ donor pool. The utilization of pediatric donor kidneys has been explored by numerous transplant centers; however, the transplant outcome and risk factors have not been well elucidated. The aim of this study was to demonstrate the safety and risk factors of transplant outcome from pediatric deceased donors. METHODS We retrospectively analyzed 484 cases of single kidney transplantation (SKT) with pediatric donor kidneys performed at our center from January 2012 to March 2021. The recipients were grouped by age: child (≤12 years; n=143), adolescents (12-18 years; n=86), and adults (≥18 years; n=255). The overall prognosis of the recipients was analyzed, and the post-transplant outcomes were compared among the three groups and assessed by univariate and multivariate analyses using the Cox proportional risk model. RESULTS The median follow-up time was 26.7 months. The 1- and 3-year patient survival rates were 98.7% and 96.8%, respectively. The 1- and 3-year death-censored graft survival (DCGS) was 96.1% and 92.7%, respectively. The overall estimated glomerular filtration rates (eGFRs) at 1 and 3 years were 80.0±24.5 and 84.2±25.2 mL/min/1.73 m2; the 3-year eGFR of the three groups were comparable and all were over 80 mL/min/1.73 m2. Rejection was an independent risk factor for death-censored graft failure within 3 years after transplantation [hazard ratio (HR) =3.85; P=0.001], and was the primary cause of graft losses in the adolescent group. Thrombosis was more common within 1-month post-transplant in the child recipients (P<0.05), and its incidence was higher in recipients with donor body weight (DBW) ≤11 kg. CONCLUSIONS SKT from pediatric donors could achieve decent outcomes. Rejection was an independent risk factor of graft survival, especially for adolescent recipients. Child recipients may compromise early transplant outcomes due to vascular thrombosis, which might be related to small (DBW ≤11 kg) pediatric donors.
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Affiliation(s)
- Mingchuan Huang
- Organ Transplant Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Wenrui Wu
- Organ Transplant Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Qiang Zhang
- Organ Transplant Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jun Li
- Organ Transplant Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Huanxi Zhang
- Organ Transplant Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Chenglin Wu
- Organ Transplant Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Qian Fu
- Organ Transplant Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Shenghui Wu
- Organ Transplant Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yanxu Chen
- Organ Transplant Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jianming Li
- Organ Transplant Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xiaojun Su
- Organ Transplant Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Longshan Liu
- Organ Transplant Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Changxi Wang
- Organ Transplant Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, China.,Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, China
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Spaggiari M, Petrochenkov E, Patel H, Di Cocco P, Almario-Alvarez J, Fratti A, Tzvetanov I, Benedetti E. Donor Size Doesn’t Impact En Bloc Kidney Transplant Outcomes: A Single-Center Experience and Review of Literature. Transpl Int 2022; 35:10731. [PMID: 36311258 PMCID: PMC9596783 DOI: 10.3389/ti.2022.10731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 09/29/2022] [Indexed: 11/13/2022]
Abstract
Few transplant programs use kidneys from donors with body weight (BW)<10 kg due to higher incidence of vascular and urological complications, and DGF. The purpose of this study was to investigate the non-inferiority of pediatric en bloc kidneys from donors with BW<10 kg. We performed a single-center retrospective analysis of en bloc kidney transplants from pediatric donor cohort (n = 46) from 2003 to 2021 and stratified the outcomes by donor BW (small group, donor BW<10 kg, n = 30; standard group, donor BW<10 kg, n = 16). Graft function, rate of early post-transplant complications, graft and patient survival were analyzed. Complication rates were similar between both groups with 1 case of arterial thrombosis in the smaller group. Overall graft and patient survival rates were similar between the small and the standard group (graft survival—90% vs. 100%, p = 0.09; patient survival—96.7 vs. 100%, p = 0.48). Serum creatinine at 1, 3, 5 years was no different between groups. Reoperation rate was higher in the small group (23.3% vs. 6.25%, p = 0.03). The allograft from small donors could be related to higher reoperation rate in the early post-transplant period, but not associated with lower long-term graft and patient survival.
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Affiliation(s)
- Mario Spaggiari
- Department of Surgery, University of Illinois at Chicago, Chicago, IL, United States
| | - Egor Petrochenkov
- Department of Surgery, University of Illinois at Chicago, Chicago, IL, United States
- *Correspondence: Egor Petrochenkov,
| | - Hiteshi Patel
- School of Medicine, University of Missouri-Kansas City, Kansas City, MO, United States
| | - Pierpaolo Di Cocco
- Department of Surgery, University of Illinois at Chicago, Chicago, IL, United States
| | - Jorge Almario-Alvarez
- Department of Surgery, University of Illinois at Chicago, Chicago, IL, United States
| | - Alberto Fratti
- Department of Surgery, University of Illinois at Chicago, Chicago, IL, United States
| | - Ivo Tzvetanov
- Department of Surgery, University of Illinois at Chicago, Chicago, IL, United States
| | - Enrico Benedetti
- Department of Surgery, University of Illinois at Chicago, Chicago, IL, United States
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Tan L, Song L, Xie Y, Peng L, Lan G, Zhang H, Jiang H, Xie X. Short-term outcome of kidney transplantation from deceased donors with nephrolithiasis. ZHONG NAN DA XUE XUE BAO. YI XUE BAN = JOURNAL OF CENTRAL SOUTH UNIVERSITY. MEDICAL SCIENCES 2022; 47:1217-1226. [PMID: 36411705 PMCID: PMC10930321 DOI: 10.11817/j.issn.1672-7347.2022.220311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVES Shortage of kidney allografts is a major barrier to end-stage renal disease patients receiving kidney transplantation, and it is necessary to enlarge the donor pool and find better ways of using available allografts. The global incidence of nephrolithiasis is increasing, nephrolithiasis affects approximately 10% of adults worldwide, and it also affects the kidney donors. However, there is little information about the use of cadaveric kidney allografts with nephrolithiasis. This study aims to evaluate the safety and outcome of kidney transplantation with allografts from the deceased donors with nephrolithiasis. METHODS A total of 520 deceased donors who was at least 10 years old, and 945 adult recipients with single kidney transplantation at the Department of Kidney Transplantation, the Second Xiangya Hospital from 2016 to 2020 were included in this study. The donors were divided into 2 groups according to nephrolithiasis diagnoses: The donors with nephrolithiasis (D + ) and the donors without nephrolithiasis (D - ). The recipients were assigned into 3 groups according to their donors and the allografts they received: The allografts from donors without nephrolithiasis (D - K - ), the allografts without nephrolithiasis from donors with nephrolithiasis (D + K - ), and the allografts with nephrolithiasis (D + K + ). The demographic and clinical data of enrolled subjects were retrospectively analyzed. The allograft discard ratio between different donors were analyzed. The one-year survival of allografts and recipients, as well as the allograft function and the complications of kidney transplantation were compared. RESULTS Fifty out of 520 donors had nephrolithiasis, and the nephrolithiasis incidence was 9.6%. We recovered 1 040 kidneys, and total discard rate was 4.4% (46/1 040). The D + group had a rate of 7% discard. The donors with kidney discard accounted for 12% in the D + group, and this was higher than that of donors in the D - group (5.1%, P <0.05). The total incidence of delayed graft function (DGF) was 7.5%, and there were no significant differences in the incidence of DGF in recipients among the D - K - , D + K - , and D + K + group (7.5% vs 6.5% vs 8.2%, P> 0.05). During the one-year follow-up, 8 allografts lost function and 19 recipients died with a functional allograft. Recipients in the D - K - , D + K - ,and D + K + groups also had no significant difference between a one-year allograft and patient survival rate ( P >0.05). However, recipients in the D + K + group had a higher level of serum creatinine [(139.2±62.46) μmol/L vs (117.19±51.22) μmol/L, P <0.05] and lower estimated glomerular filtration rate [eGFR; (56.67±23.31) mL/(min·1.73 m -2 ) vs (66.86±21.90) mL/(min·1.73 m -2 ), P <0.05] compared with recipients in the D - K - group at 12 months after transplantation. During the first year after transplantation, 4 recipients developed urolithiasis, and recipients who received allografts from the D + group donors had a higher incidence of urolithiasis than those who received allografts from the D - group donors (2.2% vs 0.2%, P <0.05). There were no significant differences in the incidence of urinary tract infections and ureteral strictures at 1 year between recipients of D + and D - donors (both P >0.05). CONCLUSIONS The cadaveric kidney allografts with nephrolithiasis could be safely used for transplantation, and the short-term outcome is acceptable. However, nephrolithiasis in donors may increase the rate of kidney discard, disturb the short-term function of allografts, and increase the risk of urolithiasis in recipients. Further research with a long-term study is needed to verify the long-term outcome of kidney transplantation using cadaveric kidney allografts with nephrolithiasis.
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Affiliation(s)
- Liang Tan
- Department of Kidney Transplantation, Second Xiangya Hospital, Central South University, Changsha 410011.
- Clinical Research Center for Organ Transplantation in Hunan Province, Changsha 410011.
| | - Lei Song
- Department of Kidney Transplantation, Second Xiangya Hospital, Central South University, Changsha 410011
- Clinical Research Center for Organ Transplantation in Hunan Province, Changsha 410011
| | - Yixin Xie
- Department of Kidney Transplantation, Second Xiangya Hospital, Central South University, Changsha 410011
- Clinical Research Center for Organ Transplantation in Hunan Province, Changsha 410011
| | - Longkai Peng
- Department of Kidney Transplantation, Second Xiangya Hospital, Central South University, Changsha 410011
- Clinical Research Center for Organ Transplantation in Hunan Province, Changsha 410011
| | - Gongbin Lan
- Department of Kidney Transplantation, Second Xiangya Hospital, Central South University, Changsha 410011
- Clinical Research Center for Organ Transplantation in Hunan Province, Changsha 410011
| | - Hedong Zhang
- Department of Kidney Transplantation, Second Xiangya Hospital, Central South University, Changsha 410011
- Clinical Research Center for Organ Transplantation in Hunan Province, Changsha 410011
| | - Hongyi Jiang
- Department of Urology, Second Xiangya Hospital, Central South University, Changsha 410011, China
| | - Xubiao Xie
- Department of Kidney Transplantation, Second Xiangya Hospital, Central South University, Changsha 410011.
- Clinical Research Center for Organ Transplantation in Hunan Province, Changsha 410011.
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