Increasing the donor pool using en bloc pediatric kidneys for transplant.
OBJECTIVE
En bloc pediatric kidney transplants (EBPKT) are still a subject of controversy. The aim of this study was to determine whether acceptable long-term graft survival and function can be achieved in EBPKT compared with the transplant of single, cadaveric, adult donor kidneys.


METHODS
A retrospective review was conducted of 66 recipients of en bloc kidneys from cadaveric pediatric donors and 434 patients who underwent transplantation with a single kidney from an adult donor between January 1990 and May 2002 at the authors' hospital. The recipients were well-matched demographically. Both transplant groups were analyzed for short- and long-term performance in terms of transplant outcome and quality of graft function.


RESULTS
Overall death-censored actuarial graft survival rates at 1 and 5 years were 89.2% and 84.6% in the adult kidney transplants (AKT) and 83.3% and 81.1% in EBPKT, respectively (P=0.56). In the EBPKT group, graft function was improved over that observed in AKT. Vascular thrombosis was the most common cause of graft loss in EBPKT. Acute rejection occurred more frequently in AKT and Cox's regression analysis indicated that undergoing an AKT was a predictive factor for acute vascular rejection (adjusted risk ratio, 3.8; 95% confidence interval, 1.4-10.2; P=0.001).


CONCLUSIONS
Overall graft survival was similar in both groups, vascular complications were the main cause of graft loss in EBPKT, and the EBPKT showed excellent long-term graft function and a low incidence of acute rejection.
Department of Nephrology, Hospital Clínico San Carlos, Facultad de Medicina, Universidad Complutense, Madrid, Spain. sanchezfruct@telefonica.net.
Ana I
AI
Sánchez-Fructuoso
Dolores
D
Prats
Maria J
MJ
Pérez-Contín
María
M
Marques
Jaime
J
Torrente
José
J
Conesa
Juan
J
Grimalt
Francisco
F
Del Rio
Jose R
JR
Núñez
Alberto
A
Barrientos
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology / Q000209:etiology; D006085:Graft Survival; D006801:Humans; D015994:Incidence; D007668:Kidney / Q000503:physiopathology; D016030:Kidney Transplantation / Q000009:adverse effects; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D012079:Renal Circulation; D012189:Retrospective Studies; D013927:Thrombosis / Q000150:complications / Q000209:etiology; D009927:Tissue and Organ Procurement / Q000379:methods*