TRANSPLANTATION OF PEDIATRIC ENBLOC CADAVER KIDNEYS INTO ADULT RECIPIENTS

Abstract

423 Purpose: We compared outcomes transplanting (TX) pediatric enbloc kidneys versus adult donor cadaver kidneys into adult recipients. Materials and Methods: To evaluate outcome using enbloc pediatric (peds) (cad) donor kidneys 33 adults (study group) transplanted between 4/90 and 9/97 using enbloc cad kidneys (mean donor age 24.3 +/-9.57 months (mths.) were compared to 33 matched adults (control group) transplanted with adult kidneys mean donor age 42.5 +/- 14.9 year (yr.). The groups were identical for TX era, immunosuppression, recipient sex, race, etiology of renal failure, mean weight and follow-up (45 vs. 44 mths.). The mean recipient age study vs control was lower (36.3 vs 48.9 yr, p=0.0003). Patient (pt.) and graft survival were compared stratifying by recipient age and weight. Also, study pt. and graft survival were stratified by enbloc donor age. Serial serum creatinine, incidence of delayed graft function (DGF) requiring dialysis, acute and chronic rejection, hypertension and proteinuria, as well as intraoperative and postoperative complications were compared. Results: There was no difference in overall pt (p=0.16) or graft survival (p=0.69) between the study (enbloc) and control (adult donor) groups with three year pt. survival 95% vs. 87% and 3-yr. graft survival 79 vs. 76% respectively. In addition, no differences in pt. or graft survival were seen based upon recipient age (14-44 vs. > 45 yr., p=0.11) enbloc donor age (<24 vs >24 mths., p=0.39) or recipient weight (<60, 61-75, >75 kg., p=0.60). The following significant differences study vs control were noted: donor terminal creatinine (0.43 vs 1.0 mg/dl, p=0.0001), cold ischemia time (28.4 vs 22.3 hours, p=0.03), utilization of ureteral stents (97 vs 18.8%, p=<0.001), and incidence of surgical complications(39.4 vs 9.1%, p=<0.001). Significant differences in creatinine study vs control at discharge (3.0 vs 7.8, p=0.06), one year (1.4 vs 2.0 mg/dl, p=0.06) and two years (2.5 vs 1.7 mg/dl, p=0.008) dissipated on follow-up at 5-years (1.1 vs 1.6 mg/dl, p=0.14). Vascular complications were more prevalent in the enbloc group: renal vein thrombosis (1), thrombosis in donor aorta (2), arterial thrombosis of medial kidney (2), and renal artery stenosis (2). Conclusions: These data suggest that transplanting pediatric enbloc cadaver kidneys into adult recipients results in equivalent patient and graft survival seen using adult donor kidneys. Also, our data suggest that peds enbloc kidneys need not be strictly allocated based upon recipient weight or age criteria. There were no differences between groups in DGF, acute or chronic rejection, hypertension, proteinuria or long-term function.