title: Pediatric en bloc kidney transplantation to adult recipients: more than suboptimal?
abstract: BACKGROUND
  To optimize available organs, kidneys from young donors traditionally believed to be suboptimal are transplanted to adults. The purpose of this study is to compare graft survival (GS) of en bloc kidney (EBK) from young pediatric donors to other deceased donor transplants in adult recipients.
  
  
  METHODS
  We analyzed United Network of Organ Sharing/STAR data on primary deceased donor kidney transplants to adult recipients (1988-2006). EBK (age younger than 5 years, n=1696) was compared with solitary pediatric (SP; age younger than 5 years) kidneys (n=1502), and matched standard adult donors (age 18-59 years, n=9594) and expanded criteria donor (ECD; n=6396). The adjusted GS was obtained using Cox proportional hazard model and hazard ratios were calculated.
  
  
  RESULTS
  EBK had lowest acute rejection rates (6.0%) but similar to standard adult transplants (6.3%), and lower than SP and ECD (9.0% and 8.2%; P<0.0001). Delayed graft function rates were lowest in EBK (17.9%), highest in ECD (34.8%; P<0.0001), and similar among SP and standard adult transplants (24.4% and 24.2%). The estimated glomerular filtration rate (eGFR) was best in EBK and worst in ECD (P<0.0001). The eGFR of EBK and SP transplants continuously improved but the eGFR of standard adult and ECD declined. Graft loss was higher in EBK and SP transplants than adult donor transplants during the first 6 months. Despite the highest thrombosis rates in EBK (5.0%) (SP, 3.3%; standard adult, 1.8%; ECD, 2.0%, P<0.0001), GS of EBK became similar to standard adult donor transplants by 5 years and best at 10 years posttransplant (64.0%) and worst in ECD (39.6%; P<0.0001).
  
  
  CONCLUSIONS
  EBK had the best long-term outcomes among deceased donor transplants and offer unique options for adult kidney transplant recipients.
authors.affiliation: Department of Internal Medicine, The University of Texas Medical Branch, Galveston, TX 77030, USA.
authors.forename: Suverta
authors.initials: S
authors.lastname: Bhayana
authors.forename: Yong-Fang
authors.initials: YF
authors.lastname: Kuo
authors.forename: Pankaj
authors.initials: P
authors.lastname: Madan
authors.forename: Sreedhar
authors.initials: S
authors.lastname: Mandaym
authors.forename: Philip G
authors.initials: PG
authors.lastname: Thomas
authors.forename: Jacqueline A
authors.initials: JA
authors.lastname: Lappin
authors.forename: James C
authors.initials: JC
authors.lastname: Rice
authors.forename: Kanae
authors.initials: K
authors.lastname: Ishihara
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002675:Child, Preschool; D046148:Donor Selection; D005260:Female; D005919:Glomerular Filtration Rate; D006084:Graft Rejection / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D006085:Graft Survival; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012042:Registries; D006435:Renal Dialysis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013927:Thrombosis / Q000209:etiology; D013997:Time Factors; D014019:Tissue Donors / Q000600:supply & distribution*; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult