Clinical efficacy of adult kidney transplantation from unilateral pediatric donor kidney / 器官移植

Objective To evaluate the clinical efficacy of adult kidney transplantation from unilateral pediatric donor kidney. Methods Clinical data of pediatric donors (n=10) and adult recipients (n=19) undergoing kidney transplantation were retrospectively analyzed. The changes of renal function, liver function and the maximal diameters of the kidney allografts were compared at 1, 7, 14, 28, 60 d after operation. The short-term survival and incidence of postoperative complications of the recipients were analyzed. Results Ten donors included 6 males and 4 females, aged (7±3) years old, with a body mass index (BMI) of (16.3±3.8) kg/m2. All donors were donation after brain death followed by cardiac death. Among 19 recipients, 12 were males and 7 were females, aged (34±12) years old, with a BMI of (20.3±1.3) kg/m2.An oblique incision was created in the lower right abdomen of the recipients. The arteries and veins of donor kidney were anastomosed with the external iliac arteries and veins of the recipients. The ureter of donor kidney was anastomosed with the bladder of the recipients. After anastomosis, the kidney was placed and fixed in the right iliac fossa. The serum creatinine and blood urea nitrogen levels of the recipients were decreased at 1 week after kidney transplantation, and restored to normal range at postoperative 2 weeks. All parameters related to liver function were normal after operation. At postoperative 1 month, the maximal diameters of the kidney allografts were (9.5±0.3) cm on average, which basically reached those of normal adults. The 1-year survival rate of 19 recipients was 95%. One recipient died from pulmonary infection after ineffective treatment. Two recipients developed rejection, and 1 recipient experienced urinary system infection, who were healed after corresponding treatment. Conclusions Adult kidney transplantation from unilateral pediatric donor kidney is safe, feasible and effective, which can be utilized to enlarge the source of donor kidneys.

Application of small-for-size graft of pediatric donor liver transplantation in an adult recipient with acute liver failure: a report of one case and literature review / 器官移植

Objective To summarize the clinical experience of small-for-size graft of pediatric donor liver transplantation in the treatment of acute liver failure in an adult recipient. Methods Clinical data of application of small-for-size graft of pediatric donor liver transplantation in an adult recipient was retrospectively analyzed and literature review was performed. Results The pediatric donor was aged 4.5 years old and the weight of donor liver from donation after brain death was 544.6 g. The body mass of recipient was 52 kg. The graft-to-recipient weight ratio was 1.05%. The classic orthotopic liver transplantation was performed. Postoperative recovery was not satisfying. The recipient suffered from brain edema, stress gastrointestinal bleeding, acute kidney injury, small-for-size liver syndrome, atelectasis, lung infection, fungal infection, abdominal infection, pleural effusion and other postoperative complications. After symptomatic and comprehensive treatment, the function of liver graft was gradually restored and regenerated to the normal size of adult liver at postoperative 2 to 3 weeks. The patient was discharged after 102 d hospitalization. During the follow-up at postoperative 10 months, the liver function was evaluated normal and the quality of life was favorable. Conclusions Pediatric small-for-size donor livers can be successfully transplanted to the adult recipients. Nevertheless, it is necessary to select the appropriate recipients, surgical methods and fine perioperative management according to the conditions of the donor livers.

Clinical efficacy and application criteria of single kidney transplantation from pediatric donors / 中华器官移植杂志

Objective To investigate the clinical outcome of single kidney transplantation from pediatric donors and to explore the application criteria.Methods The clinical data of 14 recipients undergoing renal transplantation from October 2006 to October 2016 were retrospectively analyzed.All the recipients received primary kidney transplantation from pediatric donor and the renal artery was anastomosed with external iliac artery.Based on the length of the kidney donor,the recipients were divided into two groups as group A (length beyond 6 cm) and group B (length 5-6 cm).The clinical effect and complications of the 14 recipients,the survival of the recipients and grafts,the recovery of renal function,the change of the renal length and the postoperative complications were compared between the two groups.Results The renal length in group A (n =7) was (7.5 ± 1.2) cm,and (5.7 ± 0.1) cm in group B (n =7).During the follow up period,all renal grafts and recipients survived.No significant difference was observed between two groups in renal graft function evaluated by serum creatinine and estimated glomerular filtration rate (eGFR) at 7th day,14th day,1st,2nd,3rd and 6th month postoperatively,P＞0.05.The length of transplanted kidney increased after operation in both groups,with results of 9.9 ± 0.6 cm in group A and 10.4 ± 1.5 cm in group B (P＞0.05),respectively,at 2nd month post-transplantation.Delayed graft function (DGF) occurred in 2 cases of group A and 1 case of group B.Seven cases developed proteinuria (50.0％),including 2 cases in group A (28.6％) and 5 cases in group B (71.4％).Four cases suffered hematuria (28.6％),including 2 cases in group A (28.6％) and 2 cases in group B (28.6％).One recipient in group B suffered acute rejection.No vascular embolization,urine leakage,pulmonary infection and other complications were observed in all the recipients.Conclusion The length beyond 5 cm is acceptable for single pediatric kidney donor for adult recipients with a promising clinical outcome in short-term.However,the high incidence of proteinuria and hematuria remains obstacle,and the long-term outcome needs further exploration.

Effect of single kidney transplantation from cardiac death pediatric donors to adult recipients / 实用医学杂志

Objective To observe the early clinical effect of single kidney transplantation from cardiac death pediatric donors to adult recipients. Methods Clinical data of 6 single kidney transplantations from cardiac death pediatric donors in adult recipients in Department of Organ Transplantation ,Guangdong Province No.2 People′s hospital were retrospectively analyzed. the transplant operations were carried out between January 2010 to may 2016.The median age of 6 pediatric donors was 9 years (5 years to 15 years). All recipients had the same blood type. The median age of 12 recipients was 38 years (21 years to 65 years),with 4 man and 8 women. All recipients received kidney transplantation for the first time,and overall reactive antibodies(PRA) were negative,with HLA mismatch between 1to 4. All recipients received single kidney transplantation in right fossa iliaca. Results 12 kidney transplantations were successful. The renal allografts recovered successfully without acute renal rejection , delayed graft function or primary nonfunction. Renal function of 5 of recipients immediately recovered in 5 days,5 recovered in 10 days,and 2 recovered slowly. 1 recipient manifested urine leak and recovered after drainage. 1 case developed delayed incision healing and recovered after dressing at stage II. All patients and renal grafts functions were wellnormal during follow?up period between 1 month to 36 months. Conclusion The early clinical effect of single kidney transplantation from cardiac death pediatric donors to adult recipients is good and could be a promising pathway to expand the organ donor sources.

Adult Kidney Transplantation of Pediatric En bloc Kidneys Using a Partial Bladder Wall / 대한이식학회지

Kidney transplantation is a treatment of choice which improves survival and quality of life for patients with end-stage renal disease. Due to the growing waiting list for kidney transplantation, expansion of the donor pool to use of deceased pediatric kidneys is of critical importance. However, the use of pediatric kidneys has been limited due to concerns about early graft failure, hyperfiltration injury, and technical difficulties. Performing ureteroneocystostomy using small pediatric en bloc kidneys is sometimes difficult due to the small diameter and short length of the ureter in the adult kidney recipient. We hereby report on a partial bladder wall transplantation using pediatric en bloc kidneys. Pediatric en bloc kidneys and partial bladder wall from a 12-month-old female donor who weighed 9.13 kg was transplanted into a 49-year-old male recipient. The urinary tract was reconstructed with a partial bladder wall of the donor. At 12 months post-transplantation, Doppler ultrasonograpy and renogram showed stable graft renal function without urological complications. Pediatric en bloc kidney transplantation with a partial bladder wall can be a safe and feasible surgical technique to reduce urological complications.

Simultaneous Pancreas-kidney Transplantation from Pediatric Donor: A Case Report / 대한이식학회지

Simultaneous pancreas-kidney (SPK) transplantation is a well-established treatment for patients with insulin-dependent DM complicated by ESRD. The current shortage of cadaver donors and the increasing number of diabetic patients on the transplant waiting list has prompted the use of cadaveric organ from pediatric donors. But the lower age limit of the pancreatic donors has not yet been established. We report the successful result using a 10 years old donor for a 36-year-old SPK transplant recipient.

Transplante renal em bloco de doadores-cadáveres infantis: experiência do hcfmrp-usp

The high demand for organs for transplantation has made it necessary to consider using the youngest of potential donors in order to increase the organ supply. Previous reports of decreased graft survival and increased complication rates have made surgeons wary of using such kidneys. This is a chart review with the objective to analyse the results achieved with transplantation of children kidneys ( 2 years) in the HCFMRP-USP from 1998 to 2000. A total of 5 pacients received en bloc renal transplants from donors aged 9 months to 2 years old, weighthing between 8 and 14 kg. Results: Only one patient lost the allograft within 8 days of transplantation due to allograft trombosis. Two patients had ureteral complications, one with ureteral necrosis and urinary fistula and the other with total ureterovesical anastomosis disrupture. Both were successfully repaired. Intra operatory complication was experienced in one pacient, with arterial anastomosis rupture. In loco reperfusion and repair was made. Another patient had inferior renal pole rupture, treated with polar nefrectomy at the 4º PO. Despite such problems, mean follow up of 20,7 months showed serum creatinine ranging from 0,9 to 2 mg/100ml, with no serious complications. Conclusion: Our data support the use of en bloc child cadaveric kidneys, even from infant donors less than two year of age, when the organ necessity supplant the higher rates of complications.

A grande procura de órgãos para transplante tornou necessária a aceitação de potenciais doadores pediátricos a fim de aumentar a oferta. Trabalhos anteriores relatando menor sobrevida do enxerto e taxas maiores de complicação fizeram com que cirurgiões considerassem o assunto com cautela. Esse é um estudo retrospectivo com o objetivo de analisar os resultados de transplantes renais em bloco de doadores infantis ( 2 anos) no HCFMRP-USP entre 1998 e 2000. Um total de cinco pacientes foi submetido a transplante renal em bloco de doadores com idades entre 9 meses e 2 anos de vida, pesando entre 8 e 14 kg. Apenas um paciente perdeu o enxerto no oitavo dia após transplante devido à trombose. Dois pacientes tiveram complicações ureterais, um com necrose do ureter e fístula urinária e outro com ruptura completa da anastomose ureterovesical. Ambos foram reparados com sucesso. Complicação intra-operatória foi observada em um paciente, com ruptura da anastomose arterial. Corrigiu-se com reperfusão in loco e reanastomose. Outro paciente apresentou ruptura do pólo renal inferior, tratada com nefrectomia polar no quarto dia pós-operatório. Seguimento médio de 20,7 meses mostrou, apesar de tais problemas, creatinina sérica variando entre 0,9 e 2 mg/100 ml, sem complicações sérias. Nossos achados sustentam o uso de rins infantis, em bloco, mesmo de doadores com menos de 2 anos de idade, desde que a necessidade do órgão seja maior que o risco oferecido pelo alto índice de complicações.