RENAL-FUNCTION CHANGES OVER TIME IN ADULT RECIPIENTS OF SMALL PEDIATRIC KIDNEYS - EVIDENCE AGAINST HYPERPERFUSION INJURY

There has been considerable debate regarding the use of pediatric dono r kidneys in adults with endstage renal disease. These small kidneys m ay not be able to deal with the metabolic demands of the large adult s ize, and thus pediatric kidneys may be at higher risk of loss due to h yperperfusion injury. To study the impact of small kidney size on rena l outcome, we studied two groups of patients. This retrospective revie w of patients at a single institution compared recipients of pediatric renal transplants (age <7 years, n=37) to a matched group of adult-ki dney recipients (1:2 ratio, n=74). The groups were matched for age, se x, diabetic status, HLA type, and duration of follow-up. Primary outco mes of interest were: calculated creatinine clearance at 6 months, 1 y ear, 2 years, and 3 years after transplantation and evidence of hyperp erfusion damage as determined by proteinuria, graft biopsy, and late g raft loss due to chronic rejection. This study demonstrates no signifi cant difference in calculated creatinine clearance between pediatric a nd adult transplants at 6 months (43.8 vs. 50.7 ml/min, respectively) or at 3 years after transplantation (56.3 vs. 56.2 ml/min), nor was th ere any evidence of increased proteinuria or late graft loss in the pe diatric-kidney recipients compared with adult-kidney recipients. Our d ata do not demonstrate the detrimental effects of small kidney size re lative to recipient on subsequent renal outcomes, and thus support the practice of pediatric donor kidneys being used in adult recipients wh en pediatric recipients are not available.