title: En bloc kidneys transplanted from infant donors less than 5 kg into pediatric recipients.
abstract: BACKGROUND
  Given the shortage of donor kidneys, the use of grafts from deceased infant donors is a potential approach to expand the donor pool. Four infant en bloc kidney transplants in pediatric recipients were reported, performed between 2012 and 2013 in the center.
  
  
  METHODS
  The en bloc graft was implanted extraperitoneally in the right iliac fossa. The distal end of the donor aorta was anastomosed end-to-end to the internal iliac artery, while the donor vena cava was anastomosed (end-to-side) to the external iliac vein. Both ureters were anastomosed individually to the bladder, with the exception of one case in which a donor bladder patch was anastomosed to the bladder. After the operation, the recipients received basiliximab as induction therapy followed by tacrolimus and mycophenolic acid for immunosuppression. Prophylactic anticoagulation was used postoperatively.
  
  
  RESULTS
  Recipients included two girls and two boys with age ranging from 4.6 to 11.6 years. Donor age ranged from 33 to 56 days with weight ranging from 2.5 to 5.0 kg. After a follow-up of 2 to 14 months, patient and graft survivals were 100% and 75%, respectively. Complications included delayed graft function in one patient, urine leak in one, and anticoagulation-related hemorrhage in one. One graft was lost early from vascular thrombosis. The remaining three recipients had excellent graft function with median serum creatinine of 1.1 mg/dL (range, 0.8-1.3 mg/dL) at last follow-up.
  
  
  CONCLUSIONS
  Promising outcomes can be obtained from en bloc transplantation from infant donors. The use of this donor population for pediatric recipients should be encouraged.
authors.affiliation: 1 Organ Transplantation Institute of PLA, Changzheng Hospital, Second Military Medical University, Shanghai, China. 2 Department of Nephrology and Rheumatology, Children's Hospital of Fudan University, Shanghai, China. 3 Address correspondence to: Li Zeng, Prof, M.D., Organ Transplantation Institute of PLA, Changzheng Hospital, Second Military Medical University, No. 415 Fengyang Road, Huangpu District, Shanghai 200003, China.
authors.forename: Wen-Yu
authors.initials: WY
authors.lastname: Zhao
authors.forename: Lei
authors.initials: L
authors.lastname: Zhang
authors.forename: You-Hua
authors.initials: YH
authors.lastname: Zhu
authors.forename: Yu
authors.initials: Y
authors.lastname: Chen
authors.forename: Fan-Yuan
authors.initials: FY
authors.lastname: Zhu
authors.forename: Qian
authors.initials: Q
authors.lastname: Shen
authors.forename: Hong
authors.initials: H
authors.lastname: Xu
authors.forename: Li
authors.initials: L
authors.lastname: Zeng
mesh_terms: D001835:Body Weight; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000453:epidemiology; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods; D015994:Incidence; D007223:Infant; D007676:Kidney Failure, Chronic / Q000601:surgery*; D016030:Kidney Transplantation / Q000145:classification* / Q000379:methods*; D008297:Male; D018579:Patient Selection; D012189:Retrospective Studies; D012307:Risk Factors; D014019:Tissue Donors; D014180:Transplantation; D016896:Treatment Outcome