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©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Transplant. Mar 24, 2016; 6(1): 239-248
Published online Mar 24, 2016. doi: 10.5500/wjt.v6.i1.239
Single vs dual (en bloc) kidney transplants from donors ≤ 5 years of age: A single center experience
Yousef Al-Shraideh, Umar Farooq, Hany El-Hennawy, Alan C Farney, Amudha Palanisamy, Jeffrey Rogers, Giuseppe Orlando, Muhammad Khan, Amber Reeves-Daniel, William Doares, Scott Kaczmorski, Michael D Gautreaux, Samy S Iskandar, Gloria Hairston, Elizabeth Brim, Margaret Mangus, Robert J Stratta
Yousef Al-Shraideh, Umar Farooq, Hany El-Hennawy, Alan C Farney, Jeffrey Rogers, Giuseppe Orlando, Muhammad Khan, Gloria Hairston, Elizabeth Brim, Margaret Mangus, Robert J Stratta, Department of Surgery, Wake Forest School of Medicine, Winston-Salem, NC 27157, United States
Amudha Palanisamy, Amber Reeves-Daniel, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC 27157, United States
William Doares, Scott Kaczmorski, Department of Pharmacy, Wake Forest School of Medicine, Winston-Salem, NC 27157, United States
Michael D Gautreaux, Samy S Iskandar, Department of Pathology, Wake Forest School of Medicine, Winston-Salem, NC 27157, United States
Author contributions: All of the authors contributed to this paper; Al-Shraideh Y, Farooq U, El-Hennawy H, Khan M, Doares W, Kaczmorski S, Hairston G, Brim E, Mangus M and Stratta RJ participated in research design; Al-Shraideh Y, Farooq U, Farney AC, Palanisamy A, Rogers J, Orlando G, Reeves-Daniel A, Doares W, Gautreaux MD and Stratta RJ participated in writing of the paper; Al-Shraideh Y, Farooq U, Palanisamy A, Khan M, Reeves-Daniel A, Doares W, Kaczmorski S, Iskandar SS and Stratta RJ participated in performance of the research; Al-Shraideh Y, El-Hennawy H, Rogers J, Hairston G, Brim E, Mangus M and Stratta RJ participated in data collection and analysis.
Institutional review board statement: The study was reviewed and approved for publication by our (Wake Forest University Health Sciences) Institutional Review Board.
Informed consent statement: All study participants or their legal guardian provided written informed consent about personal and medical data collection prior to study enrollment.
Conflict-of-interest statement: All of the Authors have no conflict of interest related to the manuscript.
Data sharing statement: The original anonymous dataset is available on request from the corresponding author at: rstratta@wakehealth.edu.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Robert J Stratta, Department of Surgery, Wake Forest School of Medicine, One Medical Center Blvd, Winston-Salem, NC 27157, United States. rstratta@wakehealth.edu
Telephone: +1-336-7160548 Fax: +1-336-7135055
Received: June 12, 2015
Peer-review started: June 15, 2015
First decision: September 16, 2015
Revised: October 14, 2015
Accepted: December 1, 2015
Article in press: December 2, 2015
Published online: March 24, 2016
AIM: To compare outcomes between single and dual en bloc (EB) kidney transplants (KT) from small pediatric donors.
METHODS: Monocentric nonprospective review of KTs from pediatric donors ≤ 5 years of age. Dual EB KT was defined as keeping both donor kidneys attached to the inferior vena cava and aorta, which were then used as venous and arterial conduits for the subsequent transplant into a single recipient. Donor age was less useful than either donor weight or kidney size in decision-making for kidney utilization as kidneys from donors < 8 kg or kidneys < 6 cm in length were not transplanted. Post-transplant management strategies were standardized in all patients.
RESULTS: From 2002-2015, 59 KTs were performed including 34 dual EB and 25 single KTs. Mean age of donors (17 mo vs 38 mo, P < 0.001), mean weight (11.0 kg vs 17.4 kg, P = 0.046) and male donors (50% vs 84%, P = 0.01) were lower in the dual EB compared to the single KT group, respectively. Mean cold ischemia time (21 h), kidney donor profile index (KDPI; 73% vs 62%) and levels of serum creatinine (SCr, 0.37 mg/dL vs 0.49 mg/dL, all P = NS) were comparable in the dual EB and single KT groups, respectively. Actuarial graft and patient survival rates at 5-years follow-up were comparable. There was one case of thrombosis resulting in graft loss in each group. Delayed graft function incidence (12% dual EB vs 20% single KT, P = NS) was slightly lower in dual EB KT recipients. Initial duration of hospital stay (mean 5.4 d vs 5.6 d) and the one-year incidences of acute rejection (6% vs 16%), operative complications (3% vs 4%), and major infection were comparable in the dual EB and single KT groups, respectively (all P = NS). Mean 12 mo SCr and abbreviated MDRD levels were 1.17 mg/dL vs 1.35 mg/dL and 72.5 mL/min per 1.73 m2vs 60.5 mL/min per 1.73 m2 (both P = NS) in the dual EB and single KT groups, respectively.
CONCLUSION: By transplanting kidneys from young pediatric donors into adult recipients, one can effectively expand the limited donor pool and achieve excellent medium-term outcomes.
Core tip: We evaluated outcomes in 59 kidney transplants (KT) from young pediatric donors ≤ 5 years of age including 34 dual en bloc (EB) and 25 single KTs. Mean donor age and weight were significantly lower in the dual EB compared to the single KT group. Actuarial graft and patient survival rates at 5-years follow-up were comparable as were other outcomes. With appropriate recipient selection, excellent mid-term results can be attained by transplanting kidneys from small pediatric donors into adult recipients, which effectively expands the limited donor pool. Kidney donor profile index is predictive of survival for single KT but is not accurate for predicting dual EB KT outcomes from young pediatric donors.
