Controversy exists regarding optimal use of kidneys from small pediatric donors (SPDs). The study purpose was to compare outcomes between single and dual en bloc (EB) kidney transplants (KT) from SPDs in the context of the Kidney Donor Profile index (KDPI).

METHODS: Single center retrospective review of KTs from SPDs ≤5 years of age. Recipient selection included low BMI, middle-aged adults at low immunologic risk. All patients (pts) received depleting antibody induction with FK/MMF/prednisone.

RESULTS: From 2002-2015, 59 KTs were performed from SPDs including 34 dual EB and 25 single KTs. Mean donor age (17 vs 38 months, p<0.001), mean weight (11.0 vs 17.4 kg, p=0.046) and male donors (50% vs 84%, p=0.01) were lower in the EB compared to the single KT group, respectively. Mean cold ischemia time (21 hours), KDPI (73% vs 62%) and serum creatinine (SCr) levels (0.37 vs 0.49 mg/dl, all p=NS) were comparable in the EB and single KT groups, respectively. Other than mean recipient age (38 EB vs 46 years single KT, p=0.04), there were no significant differences in pt characteristics between groups. With a mean follow-up of 5 years, actual pt (94% vs 80%, p=0.12) and graft survival (GS, 91% vs 68%, p=0.04) rates were slightly higher in EB compared to single KT, respectively (Table 2). Death-censored kidney GS rates were 93.9% and 81% (p=0.19), respectively. Delayed graft function incidence (12% EB vs 20% single KT, p=NS) was slightly lower in EB KT pts. Mean 4-year SCr and GFR levels, which improved over time in both groups, were 1.0 vs 1.17 mg/dl and 81 vs 64 ml/min/1.73 m² (both p=NS) in the EB and single KT groups. EB KT outcomes were comparable to concurrent living donor KTs and superior to standard criteria donor (SCD) KTs at our center whereas outcomes following single KT from SPDs were inferior to living donor KTs and similar to concurrent SCD KTs. Based on actual 5-year GS, the projected KDPIs of EB and single KTs from SPDs were <1% and 65%.

CONCLUSION: With appropriate pt selection, excellent mid-term outcomes can be achieved by KT from SPDs into adult recipients. KDPI is predictive of survival for single KT but is not accurate for predicting EB KT outcomes from SPDs.

CITATION INFORMATION: Khan M, El-Hennawy H, Farney A, Rogers J, Orlando G, Reeves-Daniel A, Palanisamy A, Gautreaux M, Iskandar S, Doares W, Kaczmorski S, Stratta R. Pediatric En Bloc Kidney Transplants Reduce DGF and Are Misrepresented by the KDPI. Am J Transplant. 2016;16 (suppl 3).

« Back to 2016 American Transplant Congress