title: En bloc kidney transplantation from pediatric donors: comparable outcomes with living donor kidney transplantation.
abstract: BACKGROUND
  En bloc kidneys from pediatric donors have been considered suboptimal for transplantation to adult recipients and their outcomes have rarely been compared with living donor kidney transplantation (LDKT). Traditionally, there has been hesitancy in transplanting en bloc kidneys from donors weighing less than 10 kg due to high risk of technical complications.
  
  
  METHODS
  Retrospective chart reviews were performed to compare outcomes after pediatric en bloc (n=20, mean donor weight 11.4 kg), standard criteria deceased (n=249), and living donor (n=215) kidney transplantation in adult recipients at our center. The outcomes after en bloc transplantation from young donors weighing less than or equal to 10 kg were compared with those from 11 to 15 kg donors.
  
  
  RESULTS
  The 5-year graft survival after en bloc, standard deceased, and LDKT were 92%, 70%, and 88%, respectively (P=ns). There were no vascular complications, and urine leak was seen in 1 of 20 en bloc transplants. The 1-year serum creatinine of 1.1±0.2 mg/dL in recipients from less than or equal to 10 kg donors was comparable with 0.9±0.5 mg/dL in 11 to 15 kg group (P=ns).
  
  
  CONCLUSIONS
  Excellent long-term outcome after pediatric en bloc kidney transplantation from donors weighing less than or equal to 15 kg are comparable with those after LDKT. By using meticulous surgical technique and judicious recipient selection criteria, technical graft losses can be minimized when using en bloc pediatric kidneys from donors weighing less than or equal to 10 kg. Use of pediatric en bloc kidneys should be encouraged continuously to address the problem of organ shortage.
authors.affiliation: Division of Transplantation Surgery, Department of Surgery, Virginia Commonwealth University, Richmond, VA 23298, USA. asharma@mcvh-vcu.edu
authors.forename: Amit
authors.initials: A
authors.lastname: Sharma
authors.forename: Robert A
authors.initials: RA
authors.lastname: Fisher
authors.forename: Adrian H
authors.initials: AH
authors.lastname: Cotterell
authors.forename: Anne L
authors.initials: AL
authors.lastname: King
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Maluf
authors.forename: Marc P
authors.initials: MP
authors.lastname: Posner
mesh_terms: D000328:Adult; D001835:Body Weight; D002102:Cadaver; D002675:Child, Preschool; D005260:Female; D006085:Graft Survival; D006801:Humans; D007223:Infant; D016030:Kidney Transplantation / Q000009:adverse effects / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012189:Retrospective Studies; D013997:Time Factors; D014019:Tissue Donors; D016896:Treatment Outcome