EN-BLOC TRANSPLANTATION OF KIDNEYS FROM PEDIATRIC DONORS

Purpose: Cadaveric kidneys from pediatric donors represent an importan t resource for human allotransplantation. We report 7 cases in which a new technique was used for en bloc transplantation of pediatric cadav er kidneys into adult recipients. Materials and Methods: Paired cadave ric kidneys obtained from donors younger than 6 years (mean age 26 mon ths) were transplanted en bloc into 2 children (mean age 12.5 years) a nd 5 adults (mean age 50 years) using en bloc extraperitoneal interpos ition of the donor aorta and vena cava into the recipient external ili ac artery and vein. Results: All patients had excellent perfusion imme diately following transplantation on (99m)technetium-pentetic acid per fusion scans. Serum creatinine decreased to its nadir an average of 7 days post-transplantation in all but 1 patient. In 3 patients glomerul ar filtration rate increased 3 to 5-fold at 3 months and 6 months afte r transplantation. No patient had venous or arterial thrombosis postop eratively and 2 had ureteral leaks. In 3 patients moderate to severe b iopsy proved acute rejection episodes were successfully reversed by in tensifying immunosuppressive treatment and recovery of allograft funct ion was excellent following antirejection therapy. Grafts were lost du e to chronic rejection at 10 years in 1 patient and noncompliance in 1 . Currently 5 patients are well with normal serum creatinine values at 3 months to 1 year of followup. Conclusions: En bloc transplantation of small pediatric kidneys using a new technique averts the complicati on of vascular thrombosis and provides adequate mass to achieve a norm al level of renal function.