Single versus en bloc kidney transplantation from pediatric donors less than or equal to 15 kg.
BACKGROUND
Kidney transplantation from small pediatric donors is being performed with increased frequency as single (SK) or en bloc (EBK) kidneys.


METHODS
Between 2002 and 2006, 19 EBK and 14 SK transplants from pediatric donors less than or equal to 15 kg were performed. SK arterial anastomoses were performed to the aortic patch (n=8), aortic conduit (n=1), or renal artery orifice (n=5).


RESULTS
En bloc kidney donors were on average younger (12+/-10 vs. 24+/-8 months, respectively; P=0.0102) and weighed less (10+/-3 vs. 13+/-3, respectively; P=0.0184). There were no differences between the two groups in recipient age, race, body mass index, degree of sensitization, retransplantation, and cold ischemia time; however, EBK recipients were somewhat better matched at the human leukocyte antigen DR locus (P=0.0515). Delayed graft function was more frequent in the SK group (25% vs. 0%; P=0.0542). Acute rejection occurred in 21% of recipients in both groups. Glomerular filtration rates were significantly higher with EBK than SK at 12-months posttransplantation. At 1 year, graft survival for SK and EBK was 86% and 79%, respectively (P=1.000). Graft thrombosis occurred in 0% (0/9) of SK recipients in which an aortic cuff or conduit was used, 40% (2/5) of SK recipients without an aortic cuff, and 5% (1/19) of EBK recipients (P=0.03).


CONCLUSIONS
Short-term outcomes of kidneys from small pediatric donors are satisfactory when transplanted as SKs or en bloc; however, the absence of an aortic patch in SK transplantation is a risk factor for early thrombosis.
Mohanka
Ravi
R
Department of Surgery, Thomas E Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Basu
Amit
A
Shapiro
Ron
R
Kayler
Liise K
LK
D015992:Body Mass Index; D001835:Body Weight; D002102:Cadaver; D002675:Child, Preschool; D003404:Creatinine / Q000378:metabolism; D005260:Female; D006085:Graft Survival; D006680:HLA Antigens / Q000378:metabolism; D006801:Humans; D007223:Infant; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000628:therapy*; D016030:Kidney Transplantation / Q000379:methods*; D008297:Male; D009926:Organ Preservation; D014019:Tissue Donors
D006680:HLA Antigens; D003404:Creatinine