Successful transplantation of 50 single unit pediatric kidneys ages 11 to 48 months into adult recipients

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Abstract
There is currently an imbalance between the need for cadaveric kidneys for transplantation and the supply. The medical criteria for accepting cadaveric donors are changing and organs that were originally thought to be unacceptable have functioned well. Previous reports have discussed the problems with transplanting pediatric allografts less than 4 years old into adult recipients, and the results have not been encouraging. From 1986 to 1991 a total of 50 kidneys ages 11 to 48 months were transplanted as single units into adult recipients (Group A). Ninety‐one adult donor cadaveric transplants were used as controls (Group B). The cadaveric transplants were 2nd or 3rd transplants in 7 of the Group A and 12 of the Group B patients. Renal preservation, storage times, and demographics were the same. Prednisone, cyclosporine, and either Minnesota ALG or OKT3 were used for immunosuppression in both groups. Imuran was added in immunologically high‐risk patients. The 1‐year actuarial patient and allograft survivals for Group A versus Group B were 89.5% versus 94.2% (p = 0.49) and 71.3% versus 87.8% (p=0.01). respectively. There was no difference in allograft or patient survival in kidneys from donors 11–24 months of age or 25‐48 months (p=0.56). Renal growth, as measured by sonography, occurred while on cyclosporine A. Excretory and hormonal function as measured by creatinine and hematocrit both improved. Seventy percent of the Group A patients and 76% of the Group B patients were free from rejection in the first 2 months post transplantation (p = 0.45). This is the largest single center scries using single renal units from donors less than 48 months old and demonstrates that pediatric cadaveric transplantation is both technically and physiologically feasible and that allograft and patient survival are acceptable. The subgroups within Group A of donors aged 11–24 and 25‐48 months do equally well. Excretory, hormonal function, and renal growth were excellent on cyclosporine A therapy.