Published online Mar 24, 2016. doi: 10.5500/wjt.v6.i1.239
Peer-review started: June 15, 2015
First decision: September 16, 2015
Revised: October 14, 2015
Accepted: December 1, 2015
Article in press: December 2, 2015
Published online: March 24, 2016
Processing time: 280 Days and 11.4 Hours
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.
Core tip: We evaluated outcomes in 59 kidney transplants (KT) from young pediatric donors ≤ 5 years of age including 34 dual en bloc (EB) and 25 single KTs. Mean donor age and weight were significantly lower in the dual EB compared to the single KT group. Actuarial graft and patient survival rates at 5-years follow-up were comparable as were other outcomes. With appropriate recipient selection, excellent mid-term results can be attained by transplanting kidneys from small pediatric donors into adult recipients, which effectively expands the limited donor pool. Kidney donor profile index is predictive of survival for single KT but is not accurate for predicting dual EB KT outcomes from young pediatric donors.