title: Graft survival and graft function of pediatric en bloc kidneys in paraaortal position.
abstract: BACKGROUND
  En bloc kidneys from pediatric donors are regarded as questionable with respect to the safety and quality of the transplant outcome. Therefore, we retrospectively studied graft outcome and graft function of our 56 en bloc kidneys transplanted in paraaortal position between 1992 and 1999.
  
  
  METHODS
  Graft outcome of en bloc kidneys (group A) was compared with graft outcome of single cadaveric adult donor kidneys (group B). Matched pairs were generated regarding HLA-missmatch, cold ischemic time, recipient age, body mass index, and systolic arterial blood pressure.
  
  
  RESULTS
  Allograft survival rates of pediatric en bloc kidneys at 1, 3, and 5 years were significantly lower (group A: 78, 70, 70% vs. group B: 92, 92, 81%, P<0.05). Lower survival rate was caused by a higher number of graft losses in the early postoperative period (group A: 21% vs. group B: 4%, P<0.01) due to vascular complications. Main risk factor for graft loss was donor age of less than 12 months. Five years after transplantation serum creatinine of pediatric en bloc kidneys was significantly better than of adult kidneys (0.9+/-0.06 vs. 1.8+/-0.2 mg/dl, P<0.001).
  
  
  CONCLUSIONS
  En bloc kidneys show a high percentage of graft survival with excellent long-term graft function. However, the early postoperative period carries a higher risk of graft loss in very young donors due to vascular complications. In the face of donor shortage en bloc kidneys from pediatric donors can successfully be transplanted in a paraaortal position.
authors.affiliation: Section of Transplantation Surgery and Department of Medicine, University Hospital Freiburg, Hugstetter Str 55, D-79105 Freiburg, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Strey
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Grotz
authors.forename: Christian
authors.initials: C
authors.lastname: Mutz
authors.forename: Przemyslaw
authors.initials: P
authors.lastname: Pisarski
authors.forename: Alex
authors.initials: A
authors.lastname: Furtwaengler
authors.forename: Martin
authors.initials: M
authors.lastname: Bluemke
authors.forename: Guenter
authors.initials: G
authors.lastname: Kirste
mesh_terms: D000328:Adult; D002675:Child, Preschool; D003404:Creatinine / Q000097:blood; D005260:Female; D006085:Graft Survival; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016030:Kidney Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014019:Tissue Donors
chemical_list: D003404:Creatinine