Background: Traditionally, the criteria of splitting pediatric en bloc kidneys for transplantation into two adults includes: donor age > 3 years, donor weight > 12kg, or kidney length > 6cm. To expand the donor pool, we investigated the feasibility and safety of the single kidney transplantation from pediatric donors younger than 3 years to adult recipients.

Methods: From 2013.5 to 2016.11, a total of 81 single kidney transplants from pediatric DCD (donation after citizen death) donors younger than 12 years to adult recipients were performed in our center. These patients were divided into two groups: smaller kidney group (SKG, n= 40), whose donors age < 3 years, and bigger kidney group (BKG, n=41), whose donors between 3 to 12 years old. The transplant outcome in two groups were summarized and compared.

Results: The median donor age in SKG was 1.6 years (8-35 months) and 8 years (3-11 years) in BKG. The median donor weight in SKG was 9.8kg (6-15 kg), with kidney graft lengths of 6.4±0.7cm, whereas those in BKG was 21kg (14-35 kg) and 7.9±0.8cm. For the 40 adult recipients in SKG, the median patients age and body weight were 28 years (19-52 years) and 45kg (38-62 kg) respectively. The median follow-up time was 18 months. No incidence of primary none function was observed in both group. Interestingly, the rate of DGF in SKG was not increased as expected, but was even slightly lower than that in the BKG (20% vs 29%, p>0.05). However, the serum creatinine levels of non-DGF patients in SKG decreased relatively slower than that in BKG early post-transplant, as a period of 19±11 days reaching to a normal level of SCr was spent in SKG compared to a period of 12±9 days in BKG (p<0.05). Then after, the SCr in SKG became gradually similar to that in BKG at 4-week post-transplantation (1.3±0.3 vs 1.2±0.4 mg/dL). Additionally, the average value of eGFR at 1-year follow-up was 87 ml/min/1.73m² in SKG and 80 ml/min/1.73m² in BKG (p>0.05). Acute rejection rate was low in both groups, which was 3% in SKG and 10% in BKG (p>0.05). Overall, 1-year graft survival was 85% in SKG and 90% in BKG (p>0.05).

Conclusion: By choosing appropriate adult recipients, excellent short-period transplant outcome can be achieved by using small single kidneys from pediatric donors younger than 3 years, which may represent an important way to expend the donor pool for kidney transplantation.

CITATION INFORMATION: Zhu L, Liu B, Chang S, Du D, Gong N, Jiang J, Chen Z, Chen G. Single Kidney Transplantation from Pediatric Donors Younger Than 3 Years to Adult Recipients. Am J Transplant. 2017;17 (suppl 3).

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