Early post-transplant function of 33 machine-preserved human cadaveric kidneys in children

Thirty-three of 254 machine-preserved and transplanted human cadaveric kidneys were transplanted into children 16 years of age and younger (13%). Early post-transplant function was classified as F (immediate and continuing good function), FAR (immediate good function, then accelerated rejection), SF (slow initial function), and NF (nonfunction). Early function other than F for machine-preserved kidneys of good quality from perfusion data was considered likely to be due to recipient presensitization to donor transplant antigens. The incidence of F during first transplants of good quality was 78% for recipients 12 and under, 63% for recipients 13 to 16, and 42% for adult recipients. The incidence of F for second and third transplants for these age groups was 80%, 50%, and 21%. The predictability error of antibody-against-the-panel assays (10% or more) with respect to early transplant function of other than F class was 47% (4 of 9) for recipients 16 and younger and 17% (7 of 42) for adult recipients of first, second, and third transplants. Shorter pretransplant durations of hemodialysis and the frequent use of high functional capacity adult-donor kidneys for small pediatric-age recipients are suggested as major factors contributing to these recipient-age-related early post-transplant function responses.