title: Twenty-year graft survival and graft function analysis by a matched pair study between pediatric en bloc kidney and deceased adult donors grafts.
abstract: BACKGROUND
  Pediatric en bloc kidney grafts, especially those from donors aged younger than 12 months, are still regarded controversially with respect to long-term graft survival and function as well as the postoperative development of serious hypertension and proteinuria.
  
  
  METHODS
  This retrospective single-center study analyzed 78 pediatric en bloc kidney grafts transplanted between October 1989 and December 2008. Mean donor age was 15 months in the pediatric en bloc kidney donor group and 37.8 years in the matched pair group. The mean follow-up period was 9.3 years (range, 1-19 years). Statistical analysis was performed using the Kaplan-Meier test for patient and graft survival. Continuous variables were compared using independent sample t test.
  
  
  RESULTS
  Graft survival for the pediatric donors after 1, 5, and 10 years were 83.1%, 76.0%, 73.9% and for the matched pair control group 89.6%, 78.7%, and 57.8%, respectively. Serum creatinine levels after 1, 5, and 10 years were 1.0, 0.8, 1.1 mg/dL and for the matched pair control group 1.5, 1.7, and 1.6 mg/dL, respectively. No significant long-term differences were detected between the study cohort groups with respect to the postoperative development of hypertension and proteinuria.
  
  
  CONCLUSIONS
  Overall, pediatric en bloc kidney grafts are well suited to extend the scarce kidney donor pool in experienced centers because of a superior long-term outcome for graft survival and function in comparison with deceased adult kidney grafts. Special attention has to be paid to the substantial higher initial graft loss rate during the first postoperative year.
authors.affiliation: Department of General Surgery, University of Freiburg, Hugstetter Strasse 55, D-79106 Freiburg i. Brsg., Germany. o.thomusch@gmx.de
authors.forename: Oliver
authors.initials: O
authors.lastname: Thomusch
authors.forename: Dietlind
authors.initials: D
authors.lastname: Tittelbach-Helmrich
authors.forename: Sebastian
authors.initials: S
authors.lastname: Meyer
authors.forename: Oliver
authors.initials: O
authors.lastname: Drognitz
authors.forename: Przemyslaw
authors.initials: P
authors.lastname: Pisarski
mesh_terms: D000328:Adult; D015992:Body Mass Index; D002102:Cadaver; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival / Q000502:physiology*; D006650:Histocompatibility Testing; D006801:Humans; D007223:Infant; D016030:Kidney Transplantation / Q000401:mortality / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011183:Postoperative Complications / Q000453:epidemiology; D015996:Survival Rate; D017741:Survivors; D013997:Time Factors; D014019:Tissue Donors / Q000706:statistics & numerical data*