Single Kidney Transplantation in Small Children from Small Paediatric Donors

Abstract

Background: Paediatric single kidney transplantation (sKT) from small pediatric donors (i.e. ≤ 5yrs and/or ≤10Kg) has been seeing with reluctance because of multiple factors (i.e. insufficient nephron mass, high rates of ACR and high rates of vascular and urological complications) which may negatively influence both early and late post-transplant outcome. Therefore small kidneys from paediatric donors have been usually transplanting en-bloc in adults and in children too. Up to date only one series on this topic (sKT from donor ≤ 6 yrs.) has been reported in the Literature. Aim: To analyze our single centre experience with children receiving sKT from paediatric donors < 4 years. Patients and methods: Single centre retrospective analysis of results of sKT in children < 4 years old at UKT between 2004 and 2011. Univariate analysis was performed according to t-Student test and graft/patient survival was estimated by the Kaplan-Mayer method Results: Between 2004-2011, 20 paediatric sKT have been performed at UKT: – 7 from donors ≤4 yrs (Study Group): 6 in small recipients ≤5yrs and 1 in a 16 years old recipient – 13 from donors > 5 yrs Post-operative course in Study Group: – CIT: 16,5±6,4 hours – WIT: 32±7,2 minutes – PGF in 5 – DGF (defined as Creatinine>3 for more than 5POD) in 2 – No patient received post-operative dialysis or vasopressor support – average ICU stay: 5±1,2 days – average hospital stay: 19±4,5 days – postoperative complications according to Dindo-Clavien classification o 5 Grade I-II o 1 Grade III – BPAR was observed in 1 case, successfully treated. – 1 out of the 6 small recipients developed graft loss due to chronic rejection after 6 months. He died one month later due to massive bleeding during implantation of Hickmann-Catheter. -Surival rates (mean follow-up 34 months) -Overall graft and patients survival: 95% -Overall graft and patients survival in group 1: 85,7% Conclusions: Paediatric sKT from small paediatric donors in small recipient is feasible, sure and associated with good outcome. In times of organ paucity, in order to avoid further organ wastage, renal grafts from small paediatric donors should be allocated singularly to different paediatric recipient instead en-bloc for one adult or adolescent.