Transplantation of pediatric on bloc cadaver kidneys into adult recipients

Background. To maximize the renal donor pool, cadaveric pediatric en bloc k idneys have been transplanted as a dual unit by some transplant centers. We compared the short- and long-term outcomes of adult recipients of cadaveri c pediatric en bloc renal transplants versus those of matched recipients of cadaveric adult kidneys. Methods. Thirty-three adults who received pediatric en bloc kidney transpla nts between April 1990 and September 1997 were retrospectively identified a nd were compared with 33 matched adults who received adult cadaveric kidney transplants. The groups were identical for transplantation era, immunosupp ression, recipient sex, race, cause of renal failure, mean weight, and foll ow-up duration (37.8 vs. 37.5 months). The mean recipient age study versus control was lower (36.3 vs. 48.9 years, P=0.0003). Results. There was no difference between the en bloc and adult donor groups in the 3-year patient survival rates (95% vs. 87%, P=0.16) or the 3-year g raft survival rates (87.3% vs. 84.2%, P=0.35). Further, there was no differ ence in en bloc patient or en bloc graft survival time stratified by recipi ent age (14-44 vs. >45 years, P=0.11), en bloc donor age (<24 vs. >24 month s, P=0.39), or recipient weight (<60, 61-75, >75 kg; P=0.60), Differences i n serum creatinine (mg/dl) for the en bloc versus the control group at the time of discharge (3.0 vs. 7.8 mg/dl, P=0.06), at 1 year (1.4 vs. 2.0 mg/dl , P=0.06), and at 2 years (1.1 vs. 1.6 mg/dl, P=0.14) had dissipated by the time of the 5-year follow-up examination (1.1 vs. 1.6 mg/dl, P=0.14). Vasc ular complications were more prevalent in the en bloc group: renal vein thr ombosis (one case), thrombosis of donor aorta (two cases), arterial thrombo sis of one renal moiety (two cases), and renal artery stenosis (two cases). There were no differences between groups in delayed graft function, acute or chronic rejection, posttransplant hypertension, posttransplant proteinur ia, or long-term graft function. Conclusions. Collectively, these data indicate that transplanting pediatric en bloc kidneys into adult recipients results in equivalent patient and gr aft survival compared with adult cadaveric kidneys. Further, the data also suggest that pediatric en bloc kidneys need not be strictly allocated based on recipient weight or age criteria.