Importance:

Neonatal Intensive Care Unit (NICU) kidney donation is rare but a potentially significant kidney source. Concerns with using these small kidneys include the risk for early failure from thrombosis and for injury and failure from hyperfiltration (HF). We evaluated our transplants from NICU donors focusing on changes in graft function, growth, and potential HF injury.

Methods:

All consecutive recipients of NICU donor en-bloc transplants from 2011 to 2014 were reviewed. Recipients were small with low immunologic risk. Preservation was by cold storage and pulsatile perfusion. Induction immunosuppression consisted of thymoglobulin + steroids, and maintenance of tacrolimus + MMF. Kidney growth was calculated by comparing graft length on initial post-operative ultrasound (US) to a more recent US when available. Resolution of proteinuria (PU) was defined as 3 consecutive negative urinalyses.

Results:

27 transplants were performed without mortality and with 4 early graft failures (2 graft thromboses; 2 primary non-functions). All recipients experienced post-operative PU. Of those >6 months post-transplant, 4 (22%) have unresolved PU. Grafts enlarged rapidly during the first 60 days, followed by slow growth for several months. Estimated glomerular filtration rate (e-GFR) increased steadily post-transplant.

Conclusion:

Kidneys from neonatal donors can be successfully transplanted and show significant growth and improving renal function over time. Early PU usually resolves within 6 months; however, patients with persistent PU warrant longer follow up to determine if HF injury develops. Strategies to improve outcomes, including appropriate size matching of recipients and donors, will need to focus on prevention of early thrombosis and possible HF injury.

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