Introduction: In times of organ shortage more kidneys were transplanted in ‘expanded criteria kidney' programs. This study examines the outcome of adult kidney recipients from pediatric donors. Materials and Methods: This single-center retrospective analysis evaluated eight adult patients who received a kidney from a deceased pediatric donor (age 5-17) between 06/2000 and 09/2011. Results: The median donor age was 14 years (range 5-17). The median recipient age was 49 years (range 25-57). The median cold ischemia time was 13.3 h (range 4.3-20.1), while the median warm ischemia time was 53 min (range 42-60). The median follow-up was 35.8 months (range 7-142). Acute rejection was observed in 50.0% of cases. The median HLA mismatch was 2.0. The median 1-year creatinine level was 0.95 mg/dl, the uncensored 1-year graft survival was 75.0% and the 3-year graft survival 62.5%, respectively. No recipient died within the follow-up period. As severe surgical complications, one stenosis of the renal artery and one lymphocele needing surgical revision were observed. Conclusions: Renal transplantation of a deceased single pediatric donor to an adult recipient can be performed safely and shows a good outcome. Wherever feasible, single pediatric kidney transplantation can double the number of recipients over an ‘en-bloc' transplantation. The price for a single pediatric kidney transplant may be a higher vascular complication rate and a higher rejection risk. Despite the higher risks, transplantation of a single pediatric donor kidney should be performed when accomplishable.

Keywords:
Kidney transplantation, Pediatric donors, Adult recipients, Complications, Risks
1.
Mange KC, Joffe MM, Feldman HI: Effect of the use or nonuse of long-term dialysis on the subsequent survival of renal transplants from living donors. N Engl J Med 2001;344:726-731.
2.
Meier-Kriesche HU, Kaplan B: Waiting time on dialysis as the strongest modifiable risk factor for renal transplant outcomes: a paired donor kidney analysis. Transplantation 2002;74:1377-1381.
3.
Frei U, Noeldeke J, Machold-Fabrizii V, et al: Prospective age-matching in elderly kidney transplant recipients - a 5-year analysis of the Eurotransplant Senior Program. Am J Transplant 2008;8:50-57.
4.
Uchida J, Machida Y, Iwai T, et al: Clinical outcome of ABO-incompatible living unrelated donor kidney transplantation. Urol Int 2011;86:307-314.
5.
Ichimaru N, Takahara S: Japan's experience with living-donor kidney transplantation across AB0 barriers. Nat Clin Pract Nephrol 2008;4:682-692.
6.
Giessing M, Deger S, Roigas J, et al: Cross-over kidney transplantation with simultaneous laparoscopic living donor nephrectomy: initial experience. Eur Urol 2008;53:1074-1078.
7.
Gröschl I, Wolff T, Gürke L, et al: Intermediate-term outcome of single kidney grafts from pediatric donors weighing 10-14 kg in adult recipients. Clin Transplant 2013;27:E302-E307.
8.
Sharma A, Fisher RA, Cotterell AH, et al: En bloc kidney transplantation from pediatric donors: comparable outcomes with living donor kidney transplantation. Transplantation 2011;92:564-569.
9.
Borboroglu PG, Foster CE 3rd, Philosophe B, et al: Solitary renal allografts from pediatric cadaver donors less than 2 years of age transplanted into adult recipients. Transplantation 2004;77:698-702.
10.
Hayes JM, Novick AC, Streem SB, et al: The use of single pediatric cadaver kidneys for transplantation. Transplantation 1988;45:106-110.
11.
Satterthwaite R, Aswad S, Sunga V, et al: Outcome of en bloc and single kidney transplantation from very young cadaveric donors. Transplantation 1997;63:1405-1410.
12.
Modlin C, Novick AC, Goormastic M, et al: Long-term results with single pediatric donor kidney transplants in adult recipients. J Urol 1996;156:890-895.
13.
Schröter K, Lindemann G, Fritsche L: TBase2 - a Web-Based Electronic Patient Record. Fundamenta Informaticae 43. Amsterdam, IOS Press, 2000, p 343.
14.
Port FK, Wolfe RA, Mauger EA, et al: Comparison of survival probabilities for dialysis patients vs cadaveric renal transplant recipients. JAMA 1993;270:1339-1343.
15.
Wolfe RA, Ashby VB, Milford EL, et al: Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant. N Engl J Med 1999;341:1725-1730.
16.
Oniscu GC, Brown H, Forsythe JL: Impact of cadaveric renal transplantation on survival in patients listed for transplantation. J Am Soc Nephrol 2005;16:1859-1865.
17.
Bresnahan BA, McBride MA, Cherikh WS, et al: Risk factors for renal allograft survival from pediatric cadaver donors: an analysis of united network for organ sharing data. Transplantation 2001;72:256-261.
18.
Pugliese MR, Ridolfi L, Nanni Costa A, et al: A comparison of pediatric and adult kidney donors for adult recipients. Transplant Int 1999;12:122-126.
19.
Gourlay W, Stothers L, McLoughlin MG, et al: Transplantation of pediatric cadaver kidneys into adult recipients. J Urol 1995;153:322-325.
20.
Ratner LE, Cigarroa FG, Bender JS, et al: Transplantation of single and paired pediatric kidneys into adult recipients. J Am Coll Surg 1997;185:437-445.
21.
El-Sheikh MF, Gok MA, Buckley PE, et al: En bloc pediatric into adult recipients: the Newcastle experience. Transplant Proc 2003;35:786-788.
22.
Praz V, Leisinger HJ, Pascual M, et al: Urological complications in renal transplantation from cadaveric donor grafts: a retrospective analysis of 20 years. Urol Int 2005;75:144-149.
23.
Brenner BM, Meyer TW, Hostetter TH: Dietary protein intake and the progressive nature of kidney disease: the role of hemodynamically mediated glomerular injury in the pathogenesis of progressive glomerular sclerosis in aging, renal ablation, and intrinsic renal disease. N Engl J Med 1982;307:652-659.
© 2013 S. Karger AG, Basel
2013
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.