A Study Of Single Kidney Transplantation With Kidneys From Pediatric Donation After Citizens Death

BackgroundEnd-stage renal disease is the common outcome of various progressive chronic kidney diseases,and kidney transplantation is a more effective and rational method for patients at this stage relative to dialysis.Currently,researchers are concerned about inadequate "nephron dose" because of the relatively small kidneys in infants and young children and secondary high-reperfusion injury.In other countries,most transplant centers use en bloc kidney transplantation(EBKT)for kidneys from donors aged 5 years or younger or with a weight of 21 kg or less and have achieved comparable long-term outcomes as kidney transplantations with more conventional kidney grafts.If a single-kidney transplantation method can be used,this is of great significance for alleviating the shortage of organs.In our previous study,we together with two other transplant centers in China,analyzed 102 cases of kidney transplantations with donor kidneys from deceased infants and young children aged 3 years or below and found that the three centers preferred single-kidney transplantation(SKT)with kidneys from donors aged 18 months or above and EBKT with kidneys from donors aged 4 months or below.However,the decision between SKT and EBKT was inconsistent for kidneys from donors aged from 4 months to 18 months.In this study,we retrospectively analyzed early postoperative complications and short-term outcomes of SKT versus EBKT with kidneys from donors aged from 4 months to 18 months to investigate the efficacy and safety of SKT with kidneys from deceased infants and young children and to establish new standards for the use of kidneys from infants and young children.MethodsWe collected the data from kidney transplantations performed at three transplantation centers between January 1,2012 and January 1,2017,including information on donor kidneys from deceased infants and young children aged 4 months to 18 months(n = 42)and kidney recipients(n = 57),and analyzed postoperative complications,postoperative 1-year kidney function,and 1-year patient and graft survival rates of SKT(n = 34)versus EBKT(n = 23)Results(1)A total of 57 recipients underwent kidney transplantation with kidneys from 41 infants and young children ages from 4 months to 18 months.According to the type of kidney transplantation,34 recipients and 19 donors were included in the SKT group,and 23 recipients and 23 donors were included in the EBKT group.No significant differences were observed for donor and recipient age,sex,weight,or the waiting time for donor kidney between the SKT group and the EBKT group.(2)Postoperative week 1 creatinine(290.7 ± 245.5 vs 460.8 ± 270.9,P = 0.02)and postoperative week 2 creatinine(244.1 ± 262.3 vs 414.5 ± 308.1,P = 0.03)were significantly lower in the EBKT group than in the SKT group,whereas no significant between-group differences were observed from postoperative month 1(181.3 ± 197.1 vs 266.2 ± 216.1,P = 0.15)through postoperative year 1(77.6 ± 19.3 vs 94.7 ± 31.9,P = 0.05).(3)Estimated glomerular filtration rate(eGFR)recovered much faster in the EBKT group than in the SKT group,and the between-group difference did not disappear until postoperative year 1(101.5 ± 46.6 vs 120.0 ± 24.5,P = 0.15).(4)The incidence of delayed graft function(DGF)was significantly higher in the SKT group than in the EBKT group(44.1%vs 17.3%.P = 0.03),with no significant between-group difference in other complications(47.0%vs 59.0%,P =0.36).(5)Moreover,no significant between-group differences were observed in patient overall survival rate(P = 0.08)or graft overall survival rate(P = 0.71).ConclusionThe small pediatric kidneys from aged 4 months to 18 months for renal transplantation has a definite curative effect,and the perioperative complication rate is high,especially the occurrence of pneumonia in the first half of the year,which may bring serious consequences.When the donor's age was 4-18 months,SKT had a higher risk of DGF after surgery compared with EBKT,no significant differences were observed in other postoperative complications or overall survival and the kidney function between the EBKT group and the SKT group.These results suggested that for kidney transplantation with kidneys from pediatric aged 4 months to 18 months,Experienced centers using single kidney transplantation can achieve good results and adopting SKT can effectively increase the number of available grafts and can reduce graft shortage...