Superior long-term graft function and better growth of grafts in children receiving kidneys from paediatric compared with adult donors.
BACKGROUND
Organs from paediatric donors are often not accepted for paediatric recipients because previous reports suggested inferior graft function for small kidneys transplanted in children. On the other hand, studies have shown that kidneys of adult donors transplanted into children down-regulate filtration after transplantation and may not increase their function to the need of the growing child.


METHODS
We assessed 64 male and 35 female (total n = 99) white children aged <10 years (male: mean 5.1 years, SD 2.8; female: mean 5.8 years, SD 3.4) who had received cadaveric kidney transplants at our centre between 1990 and 2005. Mean observation time was 5.9 years, SD 4.0. The children were divided into two groups depending on the kidney donor age: 63 children (mean age 5.0 years, SD 2.9) received an organ of an adult, and 39 (mean age 6.4 years, SD 3.4) of a paediatric donor. Immunosuppression was performed with prednisolone, cyclosporin A microemulsion+/-mycophenolate mofetil.


RESULTS
Three to five years after transplantation the calculated glomerular filtration rate corrected to body surface was significantly higher in recipients of paediatric organs. The size of paediatric grafts doubled in the first years after transplantation while adult grafts had a stable size. Graft survival was comparable in both groups during observation time.


CONCLUSIONS
We conclude that paediatric donor kidneys should be given preferentially to paediatric recipients due to better long-term function.
Pape
L
L
Department of Pediatric Nephrology, Visceral and Transplant Surgery, Medical School of Hannover, Germany. larspape@t-online.de
Hoppe
J
J
Becker
T
T
Ehrich
J H H
JH
Neipp
M
M
Ahlenstiel
T
T
Offner
G
G
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate / Q000502:physiology; D006085:Graft Survival / Q000502:physiology*; D006801:Humans; D007668:Kidney / Q000000981:diagnostic imaging / Q000254:growth & development*; D016030:Kidney Transplantation / Q000000981:diagnostic imaging / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D014019:Tissue Donors; D014463:Ultrasonography