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Encouraging outcomes of using a small-donor single graft in pediatric kidney transplantation

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Abstract

Background

The use of small pediatric kidneys as single grafts for transplantation is controversial, due to the potential risk for graft thrombosis and insufficient nephron mass.

Methods

Aiming to test the benefits of transplanting these kidneys, 375 children who underwent kidney transplantation in a single center were evaluated: 49 (13.1%) received a single graft from a small pediatric donor (≤ 15 kg, SPD group), 244 (65.1%) from a bigger pediatric donor (> 15 kg, BPD group), and 82 (21.9%) from adult living donors (group ALD).

Results

Groups had similar baseline main characteristics. After 5 years of follow-up, children from the SPD group were comparable to children from BPD and ALD in patient survival (94%, 96%, and 98%, respectively, p = 0.423); graft survival (89%, 88%, and 93%, respectively, p = 0.426); the frequency of acute rejection (p = 0.998); the incidence of post-transplant lymphoproliferative disease (p = 0.671); the odds ratio for severely increased proteinuria (p = 0.357); the rates of vascular thrombosis (p = 0.846); and the necessity for post-transplant surgical intervention prior to discharge (p = 0.905). The longitudinal evolution of eGFR was not uniform among groups. The three groups presented a decrease in eGFR, but the slope of the curve was steeper in ALD children. At 5 years, the eGFR of the ALD group was 10 ml/min/1.73m2 inferior to the others. At that time, the eGFR from the SPD group was statistically similar to the BPD group (p = 0.952).

Conclusion

In a specialized transplant center, the use of a single small pediatric donor kidney for transplantation is as successful as bigger pediatric or adult living donors, after 5 years of follow-up.

Graphical abstract

A higher resolution version of the Graphical abstract is available as Supplementary information.

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Data availability

Data are available and transparent.

Abbreviations

ALD:

Adult living donor

BPD:

Bigger pediatric donor (if the donor weight was > 15 kg)

CAKUT:

Congenital abnormalities of the urinary tract

CIT:

Cold ischemia time

CMV:

Cytomegalovirus

CNI:

Calcineurin inhibitor

CSA:

Ciclosporin

EBV:

Epstein-Barr virus

eGFR:

Estimated glomerular filtration rate

FSGS:

Focal and segmental glomerulosclerosis

HLA:

Human leukocyte antigen

KT:

Kidney transplantation

P/C:

Urine protein/creatinine ratio

PRA:

Panel-reactive antibody

PTLD:

Post-transplant lymphroliferative disease

RAS:

Renal artery stenosis

KRT:

Kidney replacement treatment

SPD:

Small pediatric donor (if the donor weight was ≤ 15 kg)

Tac:

Tacrolimus

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Funding

This study was funded by the Brazilian Ministry of Health through the Program for Institutional Development of the Unified Health System (Programa de Apoio ao Desenvolvimento Institucional do Sistema Único de Saúde) under Protocol No. 25000.180613/2011-11.

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Authors and Affiliations

  1. Department of Pediatric Kidney Transplantation, Hospital Samaritano de São Paulo, Rua Guapiaçu 121-91, São Paulo, SP, 04024-020, Brazil

    Luciana de Santis Feltran, Camila Penteado Genzani, Fernando Hamamoto, Mariana Janiques Barcia Magalhaes Fonseca, Maria Fernanda Carvalho de Camargo, Nara Léia Gelle de Oliveira & Fabio Cabral de Freitas Amaral

  2. Department of Vascular Surgery, Federal University of São Paulo, UNIFESP, São Paulo, Brazil

    Jose Carlos Baptista

  3. Department of Pediatric Kidney Transplantation, Hospital Samaritano de São Paulo, São Paulo, Brazil

    Paulo Cesar Koch Nogueira

  4. Department of Pediatrics, Federal University of São Paulo, UNIFESP, São Paulo, Brazil

    Paulo Cesar Koch Nogueira

Authors
  1. Luciana de Santis Feltran
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  2. Camila Penteado Genzani
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  3. Fernando Hamamoto
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  4. Mariana Janiques Barcia Magalhaes Fonseca
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  5. Maria Fernanda Carvalho de Camargo
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  6. Nara Léia Gelle de Oliveira
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  7. Fabio Cabral de Freitas Amaral
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  8. Jose Carlos Baptista
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  9. Paulo Cesar Koch Nogueira
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Contributions

LSF participated in research design, data collection, data analysis, performance of the research, and the writing of the paper. CPG participated in the performance of the research and collected data. FH participated in the performance of the research. MJBMF participated in the performance of the research. MFCC participated in research design and in the performance of the research. NLGdO participated in the performance of the research. FCdFA participated in the performance of the research. JCB participated in the performance of the research. PCK participated in research design, data analysis, using analytic tools, and the writing of the paper.

Corresponding author

Correspondence to Luciana de Santis Feltran.

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de Santis Feltran, L., Genzani, C.P., Hamamoto, F. et al. Encouraging outcomes of using a small-donor single graft in pediatric kidney transplantation. Pediatr Nephrol 37, 1137–1147 (2022). https://doi.org/10.1007/s00467-021-05296-1

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  • DOI: https://doi.org/10.1007/s00467-021-05296-1

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