Long-term results with single pediatric donor kidney transplants in adult recipients.

Abstract

PURPOSE:

We investigated whether transplantation of single pediatric donor kidneys into adults leads to an increased incidence of functional allograft impairment and complications, as previously reported.

MATERIALS AND METHODS:

To evaluate long-term functional outcome using single pediatric donor kidneys 60 adults (study group) who underwent transplantation between March 1973 and December 1988 using single pediatric donor kidneys 6 years old or younger (mean donor age plus or minus standard deviation 41.1 +/- 17.9 months) were compared to 58 matched adults (control group) who underwent transplantation with adult kidneys (mean donor age 29.7 +/- 10.8 years). The groups were identical for era of transplantation, recipient age, sex and followup (82 versus 83 months).

RESULTS:

There was no difference in patient survival between the study and control groups (p = 0.26). In the study group there were an increased requirement for early dialysis (45 versus 24%, p = 0.02), a higher incidence of proteinuria (greater than 0.8 gm./24 hours, 67 versus 48%, p = 0.04) and a higher incidence of rejection within the first 6 months (80 versus 64%, p = 0.05). There was also an increased incidence of graft failure from acute rejection in the study group. Early differences in serum creatinine levels in the 2 groups dissipated after 3 months. Renal allograft histopathology revealed no significant difference in the incidence of focal segmental glomerulosclerosis in the study versus control groups after transplantation (22.9 versus 13.3%, p = 0.70). However, focal segmental glomerulosclerosis manifested sooner after transplantation in study than control patients (mean 37 versus 82 months). After transplantation proteinuria developed in study patients with focal segmental glomerulosclerosis at a mean of 4.6 months compared to 31.8 months in controls with post-transplant focal segmental glomerulosclerosis. Graft survival in the study group was superior when cyclosporine was given rather than conventional noncyclosporine based immunosuppression. Five-year graft survival rates were 48 versus 44% for cyclosporine treated and 33 versus 44% for conventionally treated study versus control patients.

CONCLUSIONS:

These data suggest that with cyclosporine immunosuppression transplanting single pediatric kidneys into adults yields the same long-term functional graft outcome as adult donor kidneys.

• Authors: C Modlin, A C Novick, M Goormastic, E Hodge, B Mastrioanni, J Myles
• Journal: The Journal of urology (J Urol) Vol. 156 Issue 3 Pg. 890-5 (Sep 1996) ISSN: 0022-5347 [Print] United States
• PMID: 8709356 (Publication Type: Clinical Trial, Controlled Clinical Trial, Journal Article)

Topics

• Adult
• Age Factors
• Child
• Child, Preschool
• Female
• Follow-Up Studies
• Graft Survival
• Humans
• Incidence
• Infant
• Kidney Transplantation (adverse effects, mortality)
• Male
• Middle Aged
• Postoperative Complications (epidemiology)
• Prognosis
• Survival Rate
• Time Factors
• Tissue Donors