Pediatric en bloc kidney transplantation from very small (≤10 kg) donation after circulatory death (versus brain death) donors: Single-center matched-pair analysis of 130 transplants

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Abstract

En bloc kidney transplants (EBK) from very small pediatric donation after circulatory death (DCD) donors are infrequent because of the perception that DCD adversely impacts outcomes. We retrospectively studied 130 EBKs from donors ≤10 kg (65 consecutive DCD vs 65 donation after brain death [DBD] transplants; pair-matched for donor weight and terminal creatinine, and for preservation time). For DCD vs DBD, median donor weight was 5.0 vs 5.0 kg; median recipient age was 57 vs 48 years (P =.006). Graft losses from thrombosis (DCD, 5%; DBD, 7%) or primary nonfunction (DCD, 3%; DBD, 0%) were similar in both groups (P =.7). Delayed graft function rate was higher for DCD (25%) vs DBD (14%) (P =.2). Graft survival (death-censored) for DCD vs DBD at 5 years was 87% vs 91% (P =.3). Median estimated GFR (mL/min per 1.73 m2) was significantly lower for DCD recipients at 1 and 3 months; at 6 years it remained stable at 100 (DCD) and 99 (DBD). DCD impacted early posttransplant graft function, but did not appear to impart added risk for graft loss and long-term function. Very small (≤10 kg) DCD EBK donors should be considered as an option to augment the deceased kidney donor pool; larger studies with longer follow-up must confirm these findings.

Original languageEnglish (US)
Pages (from-to)2811-2817
Number of pages7
JournalAmerican Journal of Transplantation
Volume18
Issue number11
DOIs
StatePublished - Nov 1 2018

Fingerprint

Matched-Pair Analysis
Brain Death
Kidney Transplantation
Tissue Donors
Pediatrics
Transplants
Kidney
Delayed Graft Function
Weights and Measures
Graft Survival

Keywords

  • clinical research/practice
  • complication: medical/metabolic
  • complication: surgical/technical
  • donors and donation: donation after circulatory death (DCD)
  • graft survival
  • kidney transplantation/nephrology
  • organ procurement and allocation

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)

Cite this

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title = "Pediatric en bloc kidney transplantation from very small (≤10 kg) donation after circulatory death (versus brain death) donors: Single-center matched-pair analysis of 130 transplants",
abstract = "En bloc kidney transplants (EBK) from very small pediatric donation after circulatory death (DCD) donors are infrequent because of the perception that DCD adversely impacts outcomes. We retrospectively studied 130 EBKs from donors ≤10 kg (65 consecutive DCD vs 65 donation after brain death [DBD] transplants; pair-matched for donor weight and terminal creatinine, and for preservation time). For DCD vs DBD, median donor weight was 5.0 vs 5.0 kg; median recipient age was 57 vs 48 years (P =.006). Graft losses from thrombosis (DCD, 5{\%}; DBD, 7{\%}) or primary nonfunction (DCD, 3{\%}; DBD, 0{\%}) were similar in both groups (P =.7). Delayed graft function rate was higher for DCD (25{\%}) vs DBD (14{\%}) (P =.2). Graft survival (death-censored) for DCD vs DBD at 5 years was 87{\%} vs 91{\%} (P =.3). Median estimated GFR (mL/min per 1.73 m2) was significantly lower for DCD recipients at 1 and 3 months; at 6 years it remained stable at 100 (DCD) and 99 (DBD). DCD impacted early posttransplant graft function, but did not appear to impart added risk for graft loss and long-term function. Very small (≤10 kg) DCD EBK donors should be considered as an option to augment the deceased kidney donor pool; larger studies with longer follow-up must confirm these findings.",
keywords = "clinical research/practice, complication: medical/metabolic, complication: surgical/technical, donors and donation: donation after circulatory death (DCD), graft survival, kidney transplantation/nephrology, organ procurement and allocation",
author = "Christoph Troppmann and Chandrase Santhanakrishnan and Ghaneh Fananapazir and Troppmann, {Kathrin L} and Perez, {Richard V}",
year = "2018",
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doi = "10.1111/ajt.14914",
language = "English (US)",
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TY - JOUR

T1 - Pediatric en bloc kidney transplantation from very small (≤10 kg) donation after circulatory death (versus brain death) donors

T2 - Single-center matched-pair analysis of 130 transplants

AU - Troppmann, Christoph

AU - Santhanakrishnan, Chandrase

AU - Fananapazir, Ghaneh

AU - Troppmann, Kathrin L

AU - Perez, Richard V

PY - 2018/11/1

Y1 - 2018/11/1

N2 - En bloc kidney transplants (EBK) from very small pediatric donation after circulatory death (DCD) donors are infrequent because of the perception that DCD adversely impacts outcomes. We retrospectively studied 130 EBKs from donors ≤10 kg (65 consecutive DCD vs 65 donation after brain death [DBD] transplants; pair-matched for donor weight and terminal creatinine, and for preservation time). For DCD vs DBD, median donor weight was 5.0 vs 5.0 kg; median recipient age was 57 vs 48 years (P =.006). Graft losses from thrombosis (DCD, 5%; DBD, 7%) or primary nonfunction (DCD, 3%; DBD, 0%) were similar in both groups (P =.7). Delayed graft function rate was higher for DCD (25%) vs DBD (14%) (P =.2). Graft survival (death-censored) for DCD vs DBD at 5 years was 87% vs 91% (P =.3). Median estimated GFR (mL/min per 1.73 m2) was significantly lower for DCD recipients at 1 and 3 months; at 6 years it remained stable at 100 (DCD) and 99 (DBD). DCD impacted early posttransplant graft function, but did not appear to impart added risk for graft loss and long-term function. Very small (≤10 kg) DCD EBK donors should be considered as an option to augment the deceased kidney donor pool; larger studies with longer follow-up must confirm these findings.

AB - En bloc kidney transplants (EBK) from very small pediatric donation after circulatory death (DCD) donors are infrequent because of the perception that DCD adversely impacts outcomes. We retrospectively studied 130 EBKs from donors ≤10 kg (65 consecutive DCD vs 65 donation after brain death [DBD] transplants; pair-matched for donor weight and terminal creatinine, and for preservation time). For DCD vs DBD, median donor weight was 5.0 vs 5.0 kg; median recipient age was 57 vs 48 years (P =.006). Graft losses from thrombosis (DCD, 5%; DBD, 7%) or primary nonfunction (DCD, 3%; DBD, 0%) were similar in both groups (P =.7). Delayed graft function rate was higher for DCD (25%) vs DBD (14%) (P =.2). Graft survival (death-censored) for DCD vs DBD at 5 years was 87% vs 91% (P =.3). Median estimated GFR (mL/min per 1.73 m2) was significantly lower for DCD recipients at 1 and 3 months; at 6 years it remained stable at 100 (DCD) and 99 (DBD). DCD impacted early posttransplant graft function, but did not appear to impart added risk for graft loss and long-term function. Very small (≤10 kg) DCD EBK donors should be considered as an option to augment the deceased kidney donor pool; larger studies with longer follow-up must confirm these findings.

KW - clinical research/practice

KW - complication: medical/metabolic

KW - complication: surgical/technical

KW - donors and donation: donation after circulatory death (DCD)

KW - graft survival

KW - kidney transplantation/nephrology

KW - organ procurement and allocation

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U2 - 10.1111/ajt.14914

DO - 10.1111/ajt.14914

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C2 - 29722133

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SP - 2811

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JO - American Journal of Transplantation

JF - American Journal of Transplantation

SN - 1600-6135

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