title: Single pediatric kidney transplantation in adult recipients: comparable outcomes with standard-criteria deceased-donor kidney transplantation.
abstract: BACKGROUND
  Single pediatric kidney transplantation (SKT) in adult recipients has traditionally been considered a high risk because of concerns of technical complications leading to poor graft outcomes. The primary goal of this single-center, retrospective analysis was to compare outcomes after SKT to standard-criteria deceased-donor kidney transplantation (SCDKT).
  
  
  METHODS
  We compared outcomes in adult recipients after SKT (n=31; mean donor weight, 27 kg); SCDKT (n=283); pediatric en bloc (n=21), living-donor (n=275), and extended criteria-donor (n=100) kidney transplantations.
  
  
  RESULTS
  The death-censored 5-year graft survival after SKT was significantly superior to SCDKT (81.4% vs. 74.5%, P=0.02). The serum creatinine level at 5 years after transplantation was significantly lower in SKT compared with that in SCDKT (1.2 vs. 1.6 mg/dL, P<0.0001). There was a significantly higher incidence of arterial anastomotic stenosis (6.8% vs. 0.4%, P=0.02) and hydronephrosis (12.9% vs. 5.3%, P=0.02) in the SKT cohort compared with SCDKT. Subgroup analysis of the SKT cohort by donor age less than 5 years vs. 6 to 10 years (mean weight, 16.4 vs. 32.7 kg) revealed no differences in patient or graft survival.
  
  
  CONCLUSIONS
  Despite a higher incidence of posttransplantation vascular and urological complications, long-term graft survival after SKT (in weight-matched pediatric donors and selected adult recipients) was comparable with that after SCDKT. SKT from very small donors (age, ≤5 years) yielded excellent long-term patient and graft survivals. The use of pediatric donor kidneys should be encouraged to address the problem of organ shortage.
authors.affiliation: Hume-Lee Transplant Center, Virginia Commonwealth University, Richmond, VA, USA. asharma@mcvh-vcu.edu
authors.forename: Amit
authors.initials: A
authors.lastname: Sharma
authors.forename: Rajesh
authors.initials: R
authors.lastname: Ramanathan
authors.forename: Martha
authors.initials: M
authors.lastname: Behnke
authors.forename: Robert
authors.initials: R
authors.lastname: Fisher
authors.forename: Marc
authors.initials: M
authors.lastname: Posner
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D002102:Cadaver; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology*; D006085:Graft Survival / Q000502:physiology; D006801:Humans; D015994:Incidence; D007223:Infant; D016030:Kidney Transplantation / Q000502:physiology*; D019520:Living Donors; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D014019:Tissue Donors; D014180:Transplantation