Introduction:

En-bloc kidney transplantation in adult recipients using organs from pediatric donors remains controversial. The aim of the study was to investigate short- and long-term outcome in a single-center consecutive series.

Methods:

Between May 1979 and August 2011, 52 kidney transplantations were performed using en-bloc grafts obtained from pediatric donors. Recipients were divided into two groups according to donor age: ≤1 year in group 1 (n=22) and >1 year in group 2 (n=30). Post- transplant renal function, graft loss and graft and patient survivals were evaluated retrospectively.

Results:

No significant difference was observed between groups in terms of recipient age, time on dialysis, ischemia time and HLA matching. Time to reach serum creatinine level ≤ 2mg/dl was comparable in both groups. Eight grafts (36,36%) were lost during the first 6 months after grafting in group 1, while only one graft was lost in group 2 due to early rejection (3,33%, p=<0,01). In group 1, graft loss were related to graft thrombosis (3), poor function or PNF (4) and patient death (1). In three grafts, the presence of immature glomeruli was documented by histology. Long-term graft survival was significantly better in group 2 (log-rank, p=0,003). In a multivariate analysis, donor age (p=0,01) and ischemia time (p=0,02) were independent factors affecting graft survival. Patient survival did not differ between groups.

Conclusion:

En-bloc kidney transplantation from donors aged less than one year is associated with high early graft loss and poor long-term survival rates. The presence of considerable proportion of immature glomeruli and technical considerations could be the major causes.

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