Purpose

We analyzed long term outcomes of adult kidney transplant recipients from single pediatric donors at a large volume center.

Methods

A retrospective review of 90 adult kidney transplant recipients from pediatric donors aged 5 years or less was performed at a single institution over a 15 year period. Recipients of en bloc pediatric kidneys (n=10) were excluded from the analysis. Adult kidney transplants from small single pediatric donors less than 10kg (SSPD), n=32, and single pediatric donors greater than 10kg (SPD), n=48, were compared to 733 consecutive recipients of standard criteria deceased donor renal transplants during the same study period. A competing risks approach was used to estimate risk of graft failure and acute rejection. Survival outcomes were estimated using Kaplan-Meier methods.

Results

There were no significant differences in long term outcomes for adult kidney transplant recipients from SSPD compared to standard criteria donors (SCD). Five-year graft survival was 78.5% with SSPD, 91.9% with SPD, and 82.5% with SCD. The hazard ratio for graft failure for SSPD compared to SCD was 0.95 (95% CI 0.38, 2.42; p=0.921). Overall survival at 5-years was 83.9% from SSPD, 97.4% from SPD, and 82.5% from SCD. The hazard ratio (HR) for survival for SSPD compared to SCD was 0.88 (95% CI 0.33, 2.40; p=0.810). The hazard ratio for survival among recipients of SPD was significantly lower than SCD (HR 0.14, [95% CI 0.02, 0.99; p=0.049]). Acute rejection occurred in 4 (12.5%) transplants from SSPD, 6 (12.5%) transplants from SPD, and 104 (14%) transplants from SCD. Delayed graft function (DGF) occurred more frequently in SSPD than SPD, n=16 (50%) versus n=12 (25%), but it was not associated with worse graft function among recipients of pediatric donors.

Conclusion

Previous research has shown excellent long term outcomes after transplantation of en bloc pediatric kidneys for adult recipients, but long term outcomes after SSPD have not been well described. DGF appeared higher in pediatric donors <10kg. Technical complications resulting in graft failure were also rare. Long-term outcomes for acute rejection, graft survival, and overall survival did not appear to be affected and were equivalent to SCD. Utilizing small pediatric donors in appropriately selected adult recipients is safe and effective.

CITATION INFORMATION: McMillan R, Gray K, Khader T, Jabri A, Kim J, Watkins A. Long Term Outcomes of Adult Kidney Transplants from Small Single Pediatric Donors Are Equivalent to Standard Criteria Donors. Am J Transplant. 2017;17 (suppl 3).

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