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Successful Single-kidney Transplantation in Adult Recipients Using Pediatric Donors Aged 8 to 36 Months

Comparable Outcomes With Those Using Pediatric Donors Aged >3 Years

Zhu, Lan MD1,2; Fu, Cheng MD1; Chen, Song MD, PhD1,2; Liu, Bin MD, PhD1,2; Du, Dunfeng MD, PhD1,2; Chang, Sheng MD, PhD1,2; Gong, Nianqiao MD, PhD1,2; Jiang, Jipin MD1,2; Chen, Zhishui MD, PhD1,2; Chen, Gang MD, PhD1,2

doi: 10.1097/TP.0000000000002618
Original Clinical Science–General
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Background. Using pediatric donors for single-kidney transplantation (SKT) can increase the number of possible recipients. However, it is unclear when SKT involving small pediatric donors and adult recipients can safely be performed without compromising graft outcome.

Methods. From 2013 to 2017, a total of 102 SKTs in adult recipients were performed in our center using pediatric donors aged <12 years. We compared the outcomes from donors aged 8 to 36 months (the small-kidney group [SKG], n = 46) and from donors aged 3 to 12 years (the big-kidney group [BKG], n = 56). The median follow-up time was 30 months in the SKG and 28 months in the BKG.

Results. All patients achieved satisfactory renal function after transplantation, despite the fact that some patients (SKG, 19.6%; BKG, 28.6%) developed delayed graft function. One-year graft survival and death-censored graft survival in the SKG were 89.1% and 100%, respectively, comparable to the results in the BKG (92.9% and 98.2%). One year later, the graft and patient survival rates in both groups remained unchanged. Pulmonary infection was the main cause of death in patients with a functioning graft (SKG, 4 patients; BKG, 2 patients). Proteinuria occurred early in some patients (SKG, 30.4%; BKG, 19.6%) and decreased gradually within the first year posttransplantation.

Conclusions. SKT from pediatric donors aged 8 to 36 months to selected adult recipients produced excellent intermediate-term outcomes, comparable with those when older pediatric donors were used. This study provides evidence to support a lower age limit for SKT from pediatric donors.

1 Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.

2 Key Laboratory of Organ Transplantation, Ministry of Education, Ministry of Public Health, Chinese Academy of Medical Sciences, China.

Received 18 October 2018. Revision received 10 December 2018.

Accepted 15 December 2018.

The authors declare no conflicts of interest.

This work was supported by the Innovation Fund Project of Huazhong University of Science and Technology (grant 2015MS026).

L.Z. participated in performance of the research, data analysis, and writing of the article. C.F. participated in data collection. So.C. participated in data analysis and prepared the figures. B.L., D.D., Sh.C., and N.G. performed transplant surgery for some patients. J.J. participated in organ evaluation and procurement. Z.C. participated in research design. G.C. had substantial contributions to the conception of the work and interpretation of data. In addition, he performed most surgeries and critically revised the article.

Correspondence: Gang Chen, MD, PhD, or Zhishui Chen, MD, PhD, Institute of Organ Transplantation, Tongji Hospital, Huazhong University of Science and Technology, Wuhan 430030, China. (gchen@tjh.tjmu.edu.cn or zschen@tjh.tjmu.edu.cn).

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