Renal transplantation from pediatric donation after citizens death donors: a preliminary clinical report of 58 cases

Abstract

Objective To investigate the clinical prognosis and influencing factors of kidney transplantation from donation after citizens death (DCD) of pediatric donors. Method We retrospectively analyzed the clinical data of kidney transplantation from DCD pediatric donors from October 2012 to October 2015 in the First Affiliated Hospital of Zhengzhou University. We totally obtained 64 kidneys from 32 pediatric donors and performed 58 kidney transplantation containing 52 single kidney transplantations and 6 en-bloc kidney transplantations. Thirty-two donors included 26 single kidney transplantation donors and 6 en-bloc kidney transplantation donors, who were 6.5±4.9 years old (ranging from 28 days to 17 years) on average, with the mean weight of 25.1±14.4 kg (ranging from 2.5 to 67.0 kg) and the mean height of 114.0±33.8 cm (ranging from 50 to 173 cm). Fifty-eight recipients were 22.1±14.3 years old (ranging from 4 years to 52 years) on average, with the mean weight of 40.7±15.8 kg (ranging from 11 to 77 kg) and the mean height of 147.2±21.6 cm (ranging from 84 to 175 cm). Donor/recipient (D/R) body surface area (BSA) ratio ranged from 0.14 to 1.44, and the average ratio was 0.71±0.26. Through retrospective case analysis and regular follow-up, we calculated the incidence of acute rejection, delayed graft function (DGF) and surgical complications of two groups after operation. Meanwhile, we estimated renal function at 1st week, 2nd week, 1st month, 3rd month, 6th month, 12th month and 24th month postoperatively. In addition, human and graft survival rate was also calculated. Result In single kidney transplantation group, 2 recipients underwent acute rejection and resumed to normal after treatment with steroid shock therapy. Three recipients experienced with DGF. Among them, renal function of two recipients resumed to normal after 2 and 3 weeks post-operation respectively, and one pediatric recipient died from severe pulmonary infection. Graft artery stenosis occurred in 2 recipients at 2nd and 3rd month, and these 2 recipients underwent graft artery angioplasty and stent implantation respectively. There was no recurrence of graft artery stenosis during the follow-up at 12th month and 15th month respectively. Four recipients had urinary fistula. After prolongation of indwelling catheter and drainage tube, the urinary fistula was self-healed. One case of ureteral stricture of bladder was given second operation and no recurrence of stricture happened during the follow-up period of 14 months. In en-bloc kidney transplantation group, DGF occurred in 1 recipient and renal function resumed to normal after 3 weeks. Graft thrombosis occurred in 1 recipient and graft nephrectomy was performed 2 weeks post-operation. One recipient experienced with donor abdominal aorta stenosis at 4th month after transplantation, subsequently he received stent implantation and no stenosis recurred during the follow-up period of 12 months. The serum creatinine in 16 recipients during the follow-up period of over 2 years was 132.5±104.6, 117.8±62.8, 101.7±54.0, 84.1±27.9, 69.6±22.6, 74.3±30.8 and 113.8±90.3 μmol/L, and the urea nitrogen was 12.91±8.48, 11.15±5.21, 8.46±3.01, 8.27±2.04, 7.21±1.58, 7.40±1.88 and 11.30±7.38 mmol/L at post-operative 1st week, 2nd week, 1st month, 3rd month, 6th month, 12th month, and 24th month respectively. Conclusion The arterial infusion tube preparation before organ procurement should be noticed, vascular anastomosis details be improved, and meanwhile, recipients who are relatively younger, or have smaller weight and shorter maintenance dialysis time be selected. Kidney transplantation from pediatric DCD donors is feasible and applicable and can achieve relatively favorable preliminary clinical effects. Key words: Kidney transplantation; Donors; Child; Donation