Very small pediatric donor kidney transplantation in pediatric recipients

Very small pediatric donor kidney transplantation in pediatric recipients

Kidneys from very small pediatric donors (age <5 years, weight <21 kg) may be a means to increase the donor pool for pediatric recipients. Transplantation of small pediatric kidneys is more commonly performed in adult recipients due to the increased risks of technical complications, thrombosis...

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Bibliographic Details
Published in:Pediatric transplantation Vol. 21; no. 5
Main Authors: Yaffe, H. C., Friedmann, P., Kayler, L. K.
Format: Journal Article
Language:English
Published: Denmark Wiley Subscription Services, Inc 01-08-2017
Subjects:
Adolescent
Adult
Age
Age Factors
Body Weight
Child
Child, Preschool
Donor Selection - methods
Donors
Female
Follow-Up Studies
Graft rejection
Graft Survival
Grafts
Humans
Infant
Infant, Newborn
Kaplan-Meier Estimate
Kidney transplantation
Kidney Transplantation - methods
Kidney transplants
Kidneys
Male
Multivariate analysis
Outcome Assessment (Health Care)
Pediatrics
renal transplant
small pediatric kidneys
Survival
Thrombosis
Transplantation
Transplants & implants
Young Adult
graft survival
small pediatric kidneys
renal transplant
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Summary:Kidneys from very small pediatric donors (age <5 years, weight <21 kg) may be a means to increase the donor pool for pediatric recipients. Transplantation of small pediatric kidneys is more commonly performed in adult recipients due to the increased risks of technical complications, thrombosis, and early graft failure. While these risks are abrogated in adult recipients by limiting the donor weight to ≥10 kg and using the EB technique, it is unknown whether pediatric recipients achieve comparable results. US national data were assessed for all first‐time, deceased‐donor, kidney‐only pediatric recipients, 1/1996‐10/2013, who received very small pediatric donor grafts or grafts from ideal adult donors. We identified 57 pediatric EB, 110 pediatric SK, and 2350 adult transplants. The primary outcome was 3‐year all‐cause graft survival. Kaplan‐Meier curves showed worse outcomes for pediatric grafts compared to adult ideal grafts (P=.042). On multivariate analysis, pediatric recipients of SK grafts had significantly higher HRs (aHR 2.01, 95% CI 1.34‐3.00) and pediatric recipients of EB grafts had somewhat higher non‐significant HRs (1.57; 95% CI 0.88‐2.79) for graft survival. These results suggest cautionary use of very small pediatric donors as a source to expand the donor pool for pediatric candidates.
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ISSN:1397-3142
1399-3046
DOI:10.1111/petr.12924