Transplantation of adult living donor kidneys into infants and small children

HYPOTHESIS: We hypothesized that improved outcomes following renal transplantation in high-risk infants and small children primarily are due to advances in immunosuppression and accurate diagnosis of rejection. Optimizing renal allograft perfusion is critical to achieving good early graft function and decreasing early graft loss. DESIGN: Twenty-eight consecutive recipients (weighing <20 kg) of adult living donor kidneys transplanted at our center from 1984 to 1999 were reviewed. Two groups were identified based on differing immunosuppression protocols and clinical surveillance. Actuarial graft and patient survival reported at 1, 3, and 5 years were compared for group 1 (1984-1991) and group 2 (1992-1999). Graft losses, categorized as immunologic or nonimmunologic, and the incidences of delayed graft function, vascular thrombosis, and rejection were compared. RESULTS: Graft and patient survival in group 1 (n = 13) at 1, 3, and 5 years was 77% and 92%, 54% and 85%, and 54% and 85%, respectively. In group 2, all 15 patients are alive with functioning grafts to date. Immunologic graft loss occurred in 5 of 13 patients in group 1 who developed chronic rejection. Nonimmunologic causes (vascular thrombosis [2 patients]) and patient death [1]) resulted in early graft failure within 2 weeks in 3 of 13 patients in group 1. The overall incidences of delayed graft function (10.7%) and thrombosis (7.1%) were low and did not differ between groups. Percutaneous renal biopsy was used more frequently in group 2 to evaluate graft dysfunction and guide treatment. CONCLUSIONS: We conclude that improved overall graft and patient survival in group 2 is owing to advances in immunosuppression and better treatment of rejection. Percutaneous renal biopsy allows prompt and accurate histological diagnosis of graft dysfunction. Surgical technique and aggressive fluid management aimed at maximizing renal allograft perfusion is critical in optimizing early graft function and decreasing vascular complications.     

Transplantation of kidneys of relatives

In the last few decades kidney transplants have shown an increasing survival rate of about 85% after one year. The growing demand for transplants is limited by the insufficient availability of kidneys and the living donor represents a possible means of reducing the discrepancy between supply and demand. We report here results of 41 transplantations from related, living donors. The overall transplant survival rate at one year was 91% and at 5 years 71%. In the group treated with cyclosporine the survival rate was 92% at 5 years. The mean serum creatinine levels at the latest follow-up was 115 mumol/l, while the mean blood pressure was 139/82 mmHg. Donor nephrectomy resulted neither in morbidity nor mortality. An extensive follow-up study of 8 donors revealed normal values for both blood pressure and serum creatinine. Careful donor selection is crucial in order to guarantee the voluntary nature of donation and, thus, to avoid the risk of commercialism.     

Transplantation of kidneys from related living donors at Johannesburg Hospital

The Johannesburg Hospital kidney transplantation unit's experience with 111 kidney donations from living relatives between 1966 and December 1984 is reviewed. The 1-year patient survival rate for those who received transplants up to the end of 1982 was 93%. Donor surgery only caused 1 instance of serious illness and no deaths. The justification for and procedure of donor transplantation are discussed and the psychological reward to the donor highlighted.     

成人供者的双肾移植于同一受者的肾移植

目的　探讨供受者体重相差悬殊及供肾年龄>60岁以上,双肾移植给同一受者的效果。方法　受者体重>供者体重一倍及老年供者双肾移植在同一受者身上,4例双肾分别移植在两侧髂凹内,1例双肾移植在右腰髂部。结果　5 例双肾移植均恢复良好,肾功能在5~7 d内恢复正常,4例生存6月~5年,1例于术后1年死于脑血管意外。结论　受者体重>供者一倍,双肾移植能早期恢复正常肾功能。年龄>60岁以上的老年供肾,肾活检肾小球硬化(GE),GE>15%的做双肾移植,GE<15%行单肾移植,GE>50%的肾脏不能用于移植。     

Transplantation of kidneys from pediatric cadaver donors to adult recipients

Pediatric donors (less than 12 years old) are a potentially important source of kidneys for adult recipients. Previous reports of decreased graft survival and increased complication rates have made surgeons wary of using such kidneys. In 64 kidneys from younger donors transplanted to adult recipients the delayed graft function rate (41 versus 42%), and 2 and 3-year graft survival rates (67 versus 72% and 61 versus 65%, respectively) were similar to those seen with kidneys from adult donors. Kidneys from donors 24 months old or less experienced an 80% rate of graft loss at 1 year. When these kidneys are excluded the 1-year graft survival rate was similar to kidneys from older and younger donors (70 versus 77%). Mean serum creatinine at 1 year was similar in both groups (155 +/- 21 versus 151 +/- 10). Pediatric kidneys except those obtained from donors 2 years old or less are suitable for adult recipients. However, kidneys from very young donors may be more appropriate to pediatric recipients.     

Transplantation of both kidneys from 408 donors; comparison of results

Abstract The outcome of 816 paired kidney transplantations from 408 cadaveric donors was evaluated. The transplantations were divided according to order of transplant surgery into group 1 [mean cold ischemia time (CIT) 22 h] and group 2 (mean CIT 28 h). In group 1 the frequency of delayed onset of graft function (DGF) was 22% versus 35 % in group 2 (P < 0.005). The 1‐year patient survival and graft survival (GS) in group 1 was 98% and 93 % versus 94% (P < 0.005) and 90% in group 2. Hemodialysis patients in group 2 had significantly greater DGF (43 %) and poorer GS (88%) than peritoneal dialysis patients and the success of transplantation was particularly poor in recipients over 50 years of age.     

Transplantation of kidneys with renal artery aneurysm

Olakkengil SA, Mohan Rao M. Transplantation of kidneys with renal artery aneurysm.
Clin Transplant 2011: 25: E516–E519. © 2011 John Wiley & Sons A/S. Abstract: Background: The use of kidneys from a select group of living and deceased donors with renal artery aneurysms (RAA) is a novel way to increase the number of organs available for transplantation. Published literature on the outcome of transplanted kidneys with correctable vascular pathology has been reviewed. Materials and methods: The outcome of six transplant recipients who received kidneys after the repair of RAA is presented. Results: Aneurysm was an incidental finding in two live donors, and two were noticed while preparing the deceased donor grafts for transplantation. Two kidneys were salvaged after nephrectomy as the choice of treatment for the aneurysm. All grafts functioned immediately with no post‐operative complications. Conclusions: While there is scarcity for donor kidneys, these repaired kidneys should not be overlooked. Live donor kidneys with aneurysms can be transplanted successfully after appropriate surgical corrections.     

Transplantation of kidneys harvested from non-heart-beating donors: early and long-term results

Abstract  The purpose of this retrospective study was to evaluate results of non-heart-beating donor (NHBD) kidney transplantation. Between Jan 1986 and Dec 1994,80 out of 582 cadaveric kidneys were harvested from NHBD (31.9 min ± 24 after cardiac arrest). The results in the NHBD group (76 recipients) were compared with those obtained after transplantation of kidneys harvested from heart-beating donors (HBD) with respect to early graft function, and the graft and recipient's survival. Both groups were matched for sex, age, PRA level, number of HLA mismatches, and cold ischemia time. Triple immunosuppression therapy was used in both groups. Acute tubular necrosis (ATN) was observed significantly more frequently in the NHBD group (50 of 76 recipients vs 33 of 100 in the HBD group). The striking finding of this study was that the occurrence of primary non-function was the same in both groups and that the main cause of it was acute rejection. The 1-year patient and graft survival rates were 98.7 % and 81.6 % for the NHBD group and 99 % and 90 % for the HBD group, respectively. There was also no statistical difference in the serum creat-inine concentration in both groups. We concluded that despite an increased incidence of ATN in the NHBD kidney recipients, the long-term results are good and comparable with those in the HBD group.     

Transplantation of cadaver kidneys from a donor with crossed nonfused renal ectopia

Crossed nonfused renal ectopia is a rare congenital renal anomaly. Two kidneys were recovered from a 45-year-old cadaver donor with this anomaly and transplanted successfully. Complex renal anomalies should not prevent the use of such kidneys in cadaver renal transplantation.     

Transplantation of single pediatric kidneys into adult recipients

AIM: To evaluate the outcome of single pediatric kidneys transplanted into adult recipients. METHODS: A retrospective single-center review was performed of transplants from donors less than 5 years of age. Outcomes were compared with recipients of grafts from donors 18 to 45 years transplanted during the same time period. RESULTS: Thirty single renal transplants from pediatric donors and 117 transplants from adult donors between 18 and 45 years of age were performed during the study period. The mean age of the pediatric donors was 2.9 +/- 0.8 years versus 31.5 +/- 8.9 years for adult donors (P < .001). The mean age of the recipients of pediatric donors was 41.9 +/- 13 years versus 48 +/- 12.6 years for recipients of adult grafts (P = .020). The mean recipient weight of pediatric donors was 55.9 +/- 7.8 kg versus 78.0 +/- 17.7 kg for recipients of adult donors (P < .001). Sixty-six percent of pediatric donor recipients were of female gender compared to only 36% of adult donor recipients (P = .005). Death-censored actuarial graft survivals at 1 and 4 years for recipients of pediatric donor grafts were 90% and 85% compared to 93% and 85% for recipients of adult donor grafts (P = NS). The mean calculated creatinine clearances of adult donor graft recipients at 1 and 4 years posttransplantation were 70.8 +/- 26.5 and 73.7 +/- 27.2 mL/min, respectively, compared to 50.3 +/- 20.1 and 56.3 +/- 21.4 mL/min for pediatric donor grafts (P < .01 at 1 and 4 years). CONCLUSION: The use of single pediatric donor kidneys provides an excellent opportunity to safely expand the donor pool.