Pediatric Kidneys Prove Viable Transplants

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En-bloc kidney transplants provide better survival than ECD kidneys.

SAN DIEGO—En-bloc transplants of kidneys from infants and young children into adult recipients may offer better outcomes than deceased expanded criteria donor (ECD) organs, data show.

Investigators at the University of Texas Medical Branch in Galveston assessed graft survival of four types of deceased donor kidneys transplanted into adults: 1,574 single kidneys from donors age 0-4 years, 1,775 en-bloc kidneys from the same age group, 6,698 ECD kidneys, and 10,047 single standard adult kidneys (donor age 19-59 years). Subjects were matched for age, gender, region, and transplant year. Data were collected from the United Network of Organ Sharing for the years 1988-2005.

Episodes of acute rejection were lower in en-bloc than ECD transplants (6.0% vs. 8.2%) as was delayed graft function (18% vs. 34.7%). In addition, creatinine levels were better in the en-bloc than ECD recipients at six months, one year, and five years after transplantation (1.35 vs. 2.07 mg/dL at six months; 1.27 vs. 2.09 mg/dL at one year; and 1.19 vs. 2.24 mg/dL at five years).

Despite a greater incidence of thrombosis in en-bloc than ECD transplant recipients (5.1% vs. 1.7%), graft survival was similar at one year (84.4% and 83.7%) and significantly better in en-bloc than ECD patients at five years (74.2% vs. 62.9%). At 10 years, graft survival in the en-bloc transplants group was 63.4%, compared with 52.1% in the group with single kidneys from very young donors, 56.5% in the group with single adult kidneys, and 40.4% in the group with ECD kidneys.

"We need to figure out how to optimize the use of transplantable kidneys," said primary investigator Kanae Ishihara, MD, assistant professor in the department of nephrology and transplant medicine at Galveston. "Historically, we have not made the best use of the pediatric kidneys, especially when the donors are under age 5." Dr. Ishihara presented the findings here at the 39th annual meeting of the American Society of Nephrology.

En-bloc kidney transplants from very young donors may be considered as an alternative to single-standard adult cadaveric kidneys and ECD transplants if living kidney donor transplants are unavailable, Dr. Ishihara said. "This may be contrary to what some people have thought. Although the number of kidneys from very young donors has been limited, en-bloc should be considered whenever it is possible," Dr. Ishihara added.

Study co-investigator Suverta Bhayana, MD, a third-year resident in internal medicine at Galveston, observed: "We need to get the word out on this because some surgeons are not doing en-bloc because of the potential complications. However, we think everyone should consider it, and every surgeon should be comfortable with this."

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