Purpose: To review the pediatric recipients of laparoscopic donor nephrectomy (LDN) at our institution and examine predictors of adverse outcomes, particularly in patients ≤5 years old at the time of transplantation due to previous reports that have challenged the use of LDN allografts in this population.

Methods: We retrospectively reviewed donor and recipient data of 110 pediatric recipients of LDN allografts between January 2000 and November 2011. Outcomes analyzed were delayed graft function (DGF), acute rejection episodes (AREs) and allograft failure. Statistical analyses utilized Pearson chi-square or Fisher’s exact test and logistic regression. Univariate predictors with significance at the 10% level were included in multivariate models.

Results: DGF occurred in 5% of patients in the very young (≤5) and intermediate (6-17) age groups, with no DGF in the oldest (≥18) age group. Pre-transplant hemodialysis was a significant risk factor for DGF (p=0.02). One-year ARE rates were 16% for patients ≤5, 16% for patients 6-17, and 23% for patients ≥18, and overall ARE rates were 27.8%, 34.8%, and 45.5% by age group, respectively. Increasing Panel Reactive Antibody (p=0.05) and donor kidneys with multiple renal arteries (p=0.02) were identified as significant risk factors for AREs. Univariate predictors of risk for AREs were not statistically significant on multivariate regression models. Allograft survival was 100%, 98.6%, and 95.5% at 1-year and 100%, 94.2%, and 90.9% at 3-years for the very young, intermediate, and oldest age groups, respectively (median follow-up=3.7 years, range 1 month – 12.2 years). Identified risk factors for allograft failure were previous AREs (OR=6.4, 95%CI[1.8-22.8], p<0.01) and donor/recipient body surface area ratio <0.9 (OR=9.6, 95%CI[1.1-83.3], p<0.05).

Conclusions: In our experience, the use of LDN in the very young recipient subgroup is safe and beneficial. LDN is not associated with increased risk of DGF, AREs, or allograft failure in patients ≤5 years old, with 100% survival of transplanted kidneys in this group at the conclusion of the study. Preemptive transplantation should be aggressively pursued in children to avoid risks related to pre-transplantation hemodialysis. Donor/recipient body surface area ratio should be considered in the selection of donors for children undergoing kidney transplantation.

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