Transplantation of a single kidney from pediatric donors less than 10\u2009kg to children with poor access to transplantation: a two-year outcome analysis

Xiaojun Su,Longshan Liu,Jun Li,Qian Fu,Chenglin Wu,Ronghai Deng,Huanxi Zhang,Guiwen Feng,Changxi Wang,Yonghua Feng,Xinlu Pang,Björn Nashan,Wenjun Shang,Zhigang Wang

doi:10.1186/s12882-020-01895-6

Abstract

BackgroundAccess to kidney transplantation by uremic children is very limited due to the lack of donors in many countries. We sought to explore small pediatric kidney donors as a strategy to provide transplant opportunities for uremic children.MethodsA total of 56 cases of single pediatric kidney transplantation and 26 cases of en bloc kidney transplantation from pediatric donors with body weight (BW) less than 10 kg were performed in two transplant centers in China and the transplant outcomes were retrospectively analyzed.ResultsThe 1-year and 2-year death-censored graft survival in the en bloc kidney transplantation (KTx) group was inferior to that in the single KTx group. Subgroup analysis of the single KTx group found that the 1-year and 2-year death-censored graft survival in the group where the donor BW was between 5 and 10 kg was 97.7 and 90.0%, respectively. However, graft survival was significantly decreased when donor BW was ≤5 kg (p < 0.01), mainly because of the higher rate of thrombosis (p = 0.035). In the single KTx group, the graft length was increased from 6.7 cm at day 7 to 10.5 cm at 36 months posttransplant. The estimated glomerular filtration rate increased up to 24 months posttransplant. Delayed graft function and urethral complications were more common in the group with BW was ≤5 kg.ConclusionsOur study suggests that single kidney transplantation from donors weighing over 5 kg to pediatric recipients is a feasible option for children with poor access to transplantation.

Highlights

Access to kidney transplantation by uremic children is very limited due to the lack of donors in many countries
Study design From May 2014 to April 2018, all single kidney transplantations in children and en bloc kidney transplantations from pediatric donors whose body weight (BW) was below or equal to 10 kg performed at the First Affiliated Hospital of Sun Yat-sen University and the First Affiliated Hospital of Zhengzhou University were retrospectively analyzed
All kidneys were from deceased pediatric donors of one of three different donor types: donation after brain death (DBD), donation after cardiac death (DCD) and donation after brain and cardiac death (DBCD)

Summary

Introduction

Access to kidney transplantation by uremic children is very limited due to the lack of donors in many countries. We sought to explore small pediatric kidney donors as a strategy to provide transplant opportunities for uremic children. Kidney transplantation (KTx) provides a better quality of life and superior physical and psychological development for children with ESRD [3, 4]. Access to KTx by children with ESRD is limited because of the scarcity of donor kidneys in many developing countries. Only 851 pediatric KTx were performed in the past 30 years in China, accounting for fewer than 2% of total KTx during the same period [7]. It is urgent to find a new strategy to expand the organ donor pool and to improve children’s access to kidney transplantation, especially in developing countries

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