A comparison of single and double pediatric cadaver donor kidneys for transplantation

R. W G Gruessner, A. J. Matas, G. Lloveras, D. S. Fryd, D. L. Dunn, W. D. Payne, D. E R Sutherland, J. S. Najarian

Research output: Contribution to journalArticlepeer-review

22 Scopus citations

Abstract

Use of pediatric cadaver kidneys for transplantation is controversial; reports of outcome following pediatric donor transplantation have shown either similar results or worse results than when adult donors are used. Two techniques have been proposed for use of pediatric donor kidneys - transplantation of a single kidney, or transplantation of both kidneys with a common aorta and cava to a single recipient. Single kidney transplants make optimum use of the donor pool; double transplants provide increased renal mass and therefore more functional reserve in the early posttransplant period. No study from a single institution has compared outcome after double versus single pediatric cadaver kidney transplantation. To investigate this issue, we reviewed our experience with 131 pediatric cadaver kidneys (donor age ≤ 10 years) transplanted between 1971 and 1988. We compared outcome of these transplants to outcome of adult donor kidney transplants. Of the group receiving pediatric kidneys, 33 (25%) received double and 98 (75%) received single pediatric kidney transplants. For double pediatric graft recipients, 5 and 10-yr patient survival rates were 81% and 75%, respectively, whereas for single graft recipients, 5- and 10-yr patient survival rates were 67% and 54% (NS). Graft survival was 78% (1 yr) and 48% (10 yr) in double kidney transplant recipient, but only 61% (1 yr) and 34% (10 yr) in single kidney transplant recipients (p = 0.07). When compared to adult cadaver kidney transplant recipients, double graft recipients had similar short- and long-term outcome (p = 0.6), whereas single pediatric kidney recipients had significantly decreased graft survival (p = 0.03). Pathogenesis for graft loss was similar in double and single pediatric kidney transplants. However, early graft loss (within first 3 months posttransplant) due to rejection was more frequent in single (16%) than in double (3%) pediatric allograft recipients (NS). We conclude that double pediatric cadaver kidneys provide an overall higher patient and graft survival. However, optimal use of the donor pool may be made by the use of single pediatric kidney transplants.

Original languageEnglish (US)
Pages (from-to)209-214
Number of pages6
JournalClinical Transplantation
Volume3
Issue number4
StatePublished - 1989

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