Transplantation of adult recipients with single cadaveric kidneys from pediatric donors weighing <25 kg is a reliable option.

The transplantation of single kidneys from cadaveric pediatric donors into adult recipients is not routine, most being used en bloc. We reviewed our experience with the transplantation of single kidneys from pediatric donors weighing <25 kg. Thirty-two adults were transplanted with single renal allografts from pediatric donors weighing <25 kg (study group) between April 1994 and October 2003. They were compared with 30 matched adult recipients of kidneys from adult donors (control group). There was no difference between both the groups in regard to sex, age, recipient weight, HLA mismatch, PRA, type of immunosuppression and duration of follow-up. In the study group the recipients were 37.6 [+ or -] 14.3 years old with a sex ratio of 15:14 (male:female) and had median A-B-DR mismatch of 2-1-1, and a median follow-up of 23 months (range 3 to 96). Mean age of donors in study group was 4.4 [+ or -] 2.1 years, weighing 15.9 [+ or -] 5.3 kg, with a donor/recipient weight ratio of 0.22 [+ or -] 0.09. Arterial anastomosis was done with a patch, in all except one, with main arterial lumen size being 4.8 [+ or -] 2.3 mm. Ureteral stent was used in 62.5% in study group versus 25.0% of controls, P < 0.02. In the study group, surgical complications occurred in 4 of 24 patients (hydronephrosis 1, hematoma 1, and ureteric stenosis 2) needing surgical intervention in two of them. In the control group, 4 of 29 developed surgical complications (fluid collection 1, hydronephrosis 1, uretic stenosis 1, uretero-vesical leak 1) needing surgical intervention in two. Serum creatinine reached nadir in 51 days in study group versus 30 days in controls (P < 0.01). Serum creatinine at 1 and 3 years were comparable in both groups. In study group 38.9% had proteinuria at 1 year compared to 22.7% in controls (P = 0.36). One-year graft survival was 91.7% versus 92.8% for controls. Though the incidence of proteinuria is more frequent, the surgical complications, 1 and 3 year serum creatinine, and graft survival in adult recipients of single renal grafts transplanted from small pediatric donors are comparable to that of controls. Transplantation of single rather than en bloc pediatric donor kidneys yields comparable results and has the additional benefit of expanding the donor pool.

S. Meier, A.K. Sharma, S. Florman, P. Gauthier, S. Geevarghese, and D.P. Slakey, Tulane University Medical Center, New Orleans, LA.