Introduction: The use of small pediatric kidneys obtained from donors less than four years of age after cardiac death (DCD) has been limited. This is based on concerns regarding allograft function and growth and limited experience in issues of consent for organ donation and withdrawal of life support in infants. Despite the success of small en-bloc grafts from neurologically determination of death (NDD) infant donors and good outcomes with DCD grafts from larger donors, DCD en-bloc allografts from very young donors remain underutilized. In this cohort, we are excited to report our outcomes and first experience with transplantation of DCD en-bloc kidneys obtained from donors less than 4 years of age.
Methods: We reviewed all renal transplants at our institution from 2000 to 2012 to identify recipients who received an en-bloc pair of kidneys from pediatric donors less than 4 years of age. We examined recipient characteristics, perioperative characteristics, surgical complications, and allograft outcomes. The outcomes of DCD en-bloc allografts were compared with NDD en-bloc allografts.
Results: 20 recipients were identified. Four of the en-bloc kidney pairs were obtained by DCD and the remainder were procured from NDD donors. In the DCD group the mean donor age was 15.6 ± 12.0 months with weight of 9.9 ± 2.4 kg as compared the NDD group with donor age 21.6 ± 12.0 months and weight 12.9 ± 3.8 kg. All DCD allografts are currently functioning with mean GFR of 79.7 ± 21.5 mL/minute which was similar to the recipients of NDD allografts (81.5 ± 38.7 mL/minute) at one year follow-up.
Delayed graft function (DGF) was higher in the DCD group affecting two out of four (50%) recipients as compared to 12.5% of the NDD group (RR 4.0, p = 0.162).
Conclusions: We are pleased to report successful transplantation of a small cohort of en-bloc DCD kidneys from donors less than 4 years of age. Outcomes at 1 year are comparable to NDD recipients. Recipients of DCD allografts demonstrated higher rates of DGF (numbers prohibitively small to make an accurate statistical comparison).
To cite this abstract in AMA style:Rowe N, Dion M, Shum J, Weernink C, Sener A, Luke P. First Canadian Experience in Pediatric En-Bloc Renal Allograft Donation after Cardiac Death [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/first-canadian-experience-in-pediatric-en-bloc-renal-allograft-donation-after-cardiac-death/. Accessed January 25, 2021.
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