KIDNEYS FROM PEDIATRIC DONORS - RISK VERSUS BENEFIT

We encountered four adult patients who received renal transplants from young children <36 months of age, each of whom developed severe hyper tension, heavy proteinuria, and progressive renal failure. Biopsies di sclosed glomerular sclerosis with crescents in three patients and mesa ngial expansion in one. We thus analyzed our experience with 74 adults who received grafts from donors less than or equal to 10 years of age and compared the results to those of 804 patients who were transplant ed with kidneys from donors >10 years of age. A Kaplan-Meier analysis revealed that graft survival was significantly worse in patients recei ving grafts from younger, compared to older donors. This difference wa s apparent in patients treated either with or without cyclosporine. A subanalysis comparing patients with donor grafts aged less than or equ al to 5 or 6-10 years revealed a further adverse age-related effect. R enal artery thrombosis and recurrent or de novo biopsy-proven glomerul onephritis were more common in patients receiving grafts from younger donors, while graft failure from rejection actually appeared less comm on. We conclude that severe hypertension and resultant glomerular hype rperfusion promoted glomerulosclerosis and crescent formation in our p atients. Our results have caused us to pursue a more conservative appr oach towards transplanting grafts from donors aged less than or equal to 10 years into adult recipients.