Long-term outcome of pediatric renal transplantation with donors younger than 6 years
Carla Ramirez-Amorós1, Maria San Basilio1, Susana Rivas1, Roberto Lobato1, Virginia Amesty1, Pedro Lopez-Pereira1, Maria Jose Martinez-Urrutia1.
1Department of Pediatric Surgery, La Paz University Hospital, Madrid, Spain
Introduction: Renal transplantation is currently the best treatment option for patients with end-stage renal disease. However, the use of kidneys from donors under six years of age as a possibility to increase the organ pool in pediatric recipients remains a controversial matter. The objective of this study is to establish the influence of donor age on the long-term functionality of the renal graft. Likewise, we analyzed the responsiveness of the renal graft and its adaptation to ascending functional requirements in the pediatric patient.
Methods: Retrospective study of the results obtained in pediatric recipients transplanted with grafts from donors between 3 and 6 years of age, comparing them with those of grafts from donors older than 6 years. Among the variables compared are cumulative graft survival, renal size, need for antiproteinuric therapy, GFR, incidence of rejection, pyelonephritis, renal failure and surgical or tumor complications.
Results: 43 transplants were performed with donors aged 3-6 years, and 42 transplants with donors older than 6 years. Cumulative graft survival at five years was 81% for the younger donor group compared to 98% for the older donor group (p<0.05). At eight years, cumulative graft survival for donors <6 years was 74%. As for the mean estimated graft survival, it was 11.52 years for the younger donor group and 14.51 years for older donors. During follow-up, the younger donor group presented greater renal enlargement and need for antiproteinuric therapy. The older donors group had a higher GFR during the first year of follow-up, which then equalized in both groups. There were no significant differences in the incidence of acute or chronic rejection, acute pyelonephritis, acute renal failure or surgical or tumor complications.
Conclusions: Renal transplants of grafts equal to or less than six years old have good short-term and acceptable long-term results in pediatric patients.
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