RENAL-TRANSPLANTATION FROM CADAVER DONORS AGED LESS-THAN 5 YEARS OLD INTO ADULT RECIPIENTS - EXPERIENCE IN ONE-CENTER

The increasing demand of organs for transplant has justified the usage of marginal donors. The experience with pediatric donors is limited a nd its results are questionable. We report on our experience with 54 k idneys from donors below 5 years old of 574 (9.4%) kidney transplant ( KT) performed in the period 1976 to 1994. Up to July 1990, 29 of 54 we re done (A period) and since then 25 up to now (B period) by 2 differe nt surgical teams. We compare both periods, using the remainder KT as control group. Seven kidneys were from donors below 6 months old and w ere grafted as en bloc. The other 49 were grafted as units (20 from 6 months to 2 years old and 27 from 2 to 5 years old). Donors and redipi ent characteristics, ischemia times, storage and surgical technics are similar in both groups. Fifteen patients of a period were inmunosupre ssed with azatioprine plus steroids and the remainder patients were ad ministeded cyclosperine in double or triple association. Graft surviva l at 1, 2 and 5 years were 54, 50 and 39% respectively. Recipient surv ival at the same periods were 93, 90 and 80%. We did not finf differen ces in graft survival comparing both groups or about donor age (below 6 months, from 6 months to 2 years, from 2 to 5 years). Causes of graf t loss were: primary non function due to arterial thrombosis (9 cases) or venous thrombosis (1 case), arterial thrombosis (after 6 months of KT) due to failed arterial stenosis treatment (4 cases) and acute or chronic rejection (10 cases). Two grafts were lost due to cyclosperine toxicity, I with relapse of renal disease (AlgN) and 5 because recipi ent death. These 5 patients dead in the A period. Arterial thrombosis were as frequent in both groups and we did not find significatn differ ences amongst KT lost because of arterial thrombosis or rejection, acc ording to they were treated with cyclosporine or not. Twenty out io 54 kidneys are well functioning after more than 3 years, 9 more than 5 y ears and 3 more than 10 years after KT, including in this last group o ne en bloc graft from an anencephalic donor. We have not any case of h yperfiltration sindrome. Conclusions. As long as we keep on current or gan shortage, pediatric donors even neonates, should not be discarded. A successful KT is technical and functionally feasible and its surviv al limited by technical problems. These kidneys should be reserved for its transplantation in experienced Centres and preferably grafted in adult recipients.