Donor-recipient size matching influences early but not late graft function after pediatric en-bloc kidney transplantation.
BACKGROUND
Pediatric en-bloc kidney transplantation into adult recipients is an accepted technique to expand the donor pool. Concerns about adequate "nephron dosing" have traditionally favored placing these kidneys into smaller recipients.


METHODS
We reviewed 20 pediatric en-bloc transplants performed at our institution between 2002 and 2008. We examined the impact of donor age, donor weight, recipient sex, combined kidney length, recipient weight, recipient-to-donor weight ratio, and recipient weight gain on serum creatinine over time using regression analysis.


RESULTS
Patient survival was 100%. Two grafts were lost early from vascular thrombosis. Of the remaining 18 recipients, all had immediate and excellent long-term function with average creatinine of 0.91+/-0.38 mg/dL at a mean follow-up of 1257+/-656 days. For 17 patients with 1 year follow-up, recipient weight, recipient-to-donor weight ratio, and recipient male sex negatively influenced renal function at 1 month. However, this relationship was lost by 1 year with increasing function in the smallest donors and largest size mismatches. Between 1 month and 1 year posttransplant, estimated creatinine clearance improved from 59+/-13 mL/min at 1 month posttransplant to 88+/-41 mL/min (P<0.015). Weight gain after transplant was associated with improved creatinine clearance, suggesting continued adaptation over time.


CONCLUSIONS
We conclude that donor or recipient size matching up to a recipient-to-donor weight ratio of 7.5 does not significantly impact later renal function after pediatric en-bloc kidney transplantation into adults.
Halldorson
Jeffrey B
JB
Division of Transplantation, Department of Surgery, University of Washington, Seattle, WA 98195, USA. jhalldor@u.washington.edu
Bakthavatsalam
Ramasamy
R
Salvalaggio
Paolo R
PR
Pichler
Raimund H
RH
Kendrick
Elizabeth A
EA
Reyes
Jorge D
JD
Davis
Connie L
CL
Leca
Nicolae
N
D000328:Adult; D001835:Body Weight; D001926:Brain Death; D002648:Child; D003404:Creatinine / Q000097:blood / Q000652:urine; D005260:Female; D006650:Histocompatibility Testing; D006801:Humans; D007668:Kidney / Q000033:anatomy & histology* / Q000502:physiology; D007674:Kidney Diseases / Q000145:classification / Q000601:surgery; D016030:Kidney Transplantation / Q000276:immunology / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D009926:Organ Preservation / Q000379:methods; D009929:Organ Size; D012189:Retrospective Studies
D003404:Creatinine