ESPN 51th Annual Meeting

ESPN 2018


 
OUTCOME OF KIDNEY TRANSPLANTATION FROM YOUNG PEDIATRIC DONORS (AGED LESS THAN 6 YEARS) TO YOUNG SIZE-MATCHED RECIPIENTS
MERCEDES LóPEZ 1 ROMY GANDER 1 MARINO ASENSIO 1 ALEJANDRO CRUZ 1 MARINA MUñOZ 1 ENRIQUE LARA 1 RAMóN VILALTA 1 GEMA ARICETA 1

1- UNIVERSITY HOSPITAL VALL D´HEBRON
 
Introduction:

Pediatric donation is underutilized due to presumed increased risk of vascular thrombosis (VT)  and graft loss. Using young pediatric donors (YPD) for young pediatric recipients (YPR)  is suggested to be even at greater risk and therefore precluded in many centers.

Material and methods:

 Retrospective study of 118 pediatric KT performed between January 2007-July 2017. We  identified KT with YPD (considered as those aged <6 years) and age-matched YPR. Data were collected regarding donor and recipients characteristics, surgical and urological complications, graft loss and outcomes.

Results:

Forty cases of YPD to age-matched YPR were identified (33.89%). Mean recipient and donor age were 2.9 years (SD:1.68) and 2.24 years (SD: 1.5), respectively. Mean recipient and donor weight were 12.7 kg (SD: 4.1) and 13.7 kg (SD:4.15), respectively. Thirty (75%) recipients weighed <15kg. 9 out of 40 patients (22.5%) had received a previous KT. 

Major complications requiring reintervention occurred in 7 patients (17.5%): 3 VT, 3 bleeding episodes and 1 ureteral necrosis. Remarkably, only 1 surgical complication (VT) resulted in graft loss.

Over time 8 patients lost their graft (20%), 6 (15%) during the first year post-KT:  2 due to acute humoral rejection without specific donor antibodies (angiotension II type 1 receptor antibodies and MICA), 2 without primary function of the graft, 1 immediate venous thrombosis and 1 without perfusion of the upper pole of the graft with subsequent deterioration of renal function. Only in 4 cases (9.7%) the failure of the KT can be attributed to the size of D and R. 

In the present moment graft survival at 1,5-10 years in our YPD to age-matched YPR cohort was 83%-78% -78%, respectively. Median follow-up was 43.5 months (6-123 months).

Conclusions:

In expert centers, KT from YPD to age-matched YPR obtains good results even in patients at high risk of thrombotic and / or immunological risk.