Transplantation of single and paired pediatric kidneys into adult recipients
The transplantation of kidneys from cadaveric donors < or = 5 years of age into adult recipients is controversial. The large disparity between donor renal mass and recipient body mass is feared to be problematic. Controversy also exists whether to transplant kidneys from these young donors indivi...
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| Veröffentlicht in: | Journal of the American College of Surgeons 1997-11, Vol.185 (5), p.437-445 |
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| creator | RATNER, L. E CIGARROA, F. G BENDER, J. S MAGNUSON, T KRAUS, E. S |
| description | The transplantation of kidneys from cadaveric donors < or = 5 years of age into adult recipients is controversial. The large disparity between donor renal mass and recipient body mass is feared to be problematic. Controversy also exists whether to transplant kidneys from these young donors individually or as a pair into a single recipient.
We retrospectively reviewed our experience from January 1991 to January 1995 with 22 adult renal transplantations using kidneys from cadaveric donors < or = 5 years of age. Ten patients received single allografts. Twelve received organs paired en bloc. Fifty-two adult recipients from cadaveric donors aged 18-55 years served as controls. All patients received cyclosporine-based immunosuppression. Recipient characteristics did not differ significantly between the groups.
Actuarial patient and graft survival rates were similar for the two groups. The incidence of urinary complications was higher in the recipients of pediatric kidneys than in the adult-donor group (18.2% versus 3.8%, respectively, p = not significant). No grafts were lost from urinary complications. Renal function, as determined by the calculated creatinine clearance, was significantly greater in the pediatric group (76.1 +/- 4.0 versus 61.4 +/- 23.2 mL/min, p = 0.035) by 6 months after transplantation. Recipients of paired pediatric kidneys initially had better renal function (63.9 +/- 21.4 mL/min) than those receiving single pediatric kidneys (38.2 +/- 11.6 mL/min) (p = 0.004), but by 6 months, no significant difference existed. At 2 years, renal function in the pediatric-donor group remained significantly better than in the adult-donor group. Hematocrit levels as a measure of erythropoiesis were similar for single pediatric, paired pediatric, and adult-donor recipients.
Kidneys from cadaveric donors < or = 5 years of age are suitable for transplantation into adults. Pediatric kidneys provide excellent renal function despite an initially tremendous disparity between renal mass and recipient body mass. Rapid true renal growth probably occurs. No appreciable advantage is achieved by using two pediatric kidneys for a single recipient. |
| doi_str_mv | 10.1016/S1072-7515(98)80024-0 |
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We retrospectively reviewed our experience from January 1991 to January 1995 with 22 adult renal transplantations using kidneys from cadaveric donors < or = 5 years of age. Ten patients received single allografts. Twelve received organs paired en bloc. Fifty-two adult recipients from cadaveric donors aged 18-55 years served as controls. All patients received cyclosporine-based immunosuppression. Recipient characteristics did not differ significantly between the groups.
Actuarial patient and graft survival rates were similar for the two groups. The incidence of urinary complications was higher in the recipients of pediatric kidneys than in the adult-donor group (18.2% versus 3.8%, respectively, p = not significant). No grafts were lost from urinary complications. Renal function, as determined by the calculated creatinine clearance, was significantly greater in the pediatric group (76.1 +/- 4.0 versus 61.4 +/- 23.2 mL/min, p = 0.035) by 6 months after transplantation. Recipients of paired pediatric kidneys initially had better renal function (63.9 +/- 21.4 mL/min) than those receiving single pediatric kidneys (38.2 +/- 11.6 mL/min) (p = 0.004), but by 6 months, no significant difference existed. At 2 years, renal function in the pediatric-donor group remained significantly better than in the adult-donor group. Hematocrit levels as a measure of erythropoiesis were similar for single pediatric, paired pediatric, and adult-donor recipients.
Kidneys from cadaveric donors < or = 5 years of age are suitable for transplantation into adults. Pediatric kidneys provide excellent renal function despite an initially tremendous disparity between renal mass and recipient body mass. Rapid true renal growth probably occurs. No appreciable advantage is achieved by using two pediatric kidneys for a single recipient.</description><identifier>ISSN: 1072-7515</identifier><identifier>EISSN: 1879-1190</identifier><identifier>DOI: 10.1016/S1072-7515(98)80024-0</identifier><identifier>PMID: 9358086</identifier><language>eng</language><publisher>New York, NY: Elsevier Science</publisher><subject>Actuarial Analysis ; Adolescent ; Adult ; Biological and medical sciences ; Cadaver ; Child, Preschool ; Creatinine - metabolism ; Graft Survival ; Hematocrit ; Humans ; Kidney - physiopathology ; Kidney Transplantation - methods ; Kidney Transplantation - physiology ; Medical sciences ; Middle Aged ; Postoperative Complications ; Retrospective Studies ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Surgery of the urinary system ; Transplantation, Homologous</subject><ispartof>Journal of the American College of Surgeons, 1997-11, Vol.185 (5), p.437-445</ispartof><rights>1998 INIST-CNRS</rights><rights>Copyright Franklin H. Martin Memorial Foundation Nov 1997</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c360t-e2a778a1b886599de6290e68aeae2d4ffc4da26234c9df493f756abfcc984ff3</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=2068903$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/9358086$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>RATNER, L. E</creatorcontrib><creatorcontrib>CIGARROA, F. G</creatorcontrib><creatorcontrib>BENDER, J. S</creatorcontrib><creatorcontrib>MAGNUSON, T</creatorcontrib><creatorcontrib>KRAUS, E. S</creatorcontrib><title>Transplantation of single and paired pediatric kidneys into adult recipients</title><title>Journal of the American College of Surgeons</title><addtitle>J Am Coll Surg</addtitle><description>The transplantation of kidneys from cadaveric donors < or = 5 years of age into adult recipients is controversial. The large disparity between donor renal mass and recipient body mass is feared to be problematic. Controversy also exists whether to transplant kidneys from these young donors individually or as a pair into a single recipient.
We retrospectively reviewed our experience from January 1991 to January 1995 with 22 adult renal transplantations using kidneys from cadaveric donors < or = 5 years of age. Ten patients received single allografts. Twelve received organs paired en bloc. Fifty-two adult recipients from cadaveric donors aged 18-55 years served as controls. All patients received cyclosporine-based immunosuppression. Recipient characteristics did not differ significantly between the groups.
Actuarial patient and graft survival rates were similar for the two groups. The incidence of urinary complications was higher in the recipients of pediatric kidneys than in the adult-donor group (18.2% versus 3.8%, respectively, p = not significant). No grafts were lost from urinary complications. Renal function, as determined by the calculated creatinine clearance, was significantly greater in the pediatric group (76.1 +/- 4.0 versus 61.4 +/- 23.2 mL/min, p = 0.035) by 6 months after transplantation. Recipients of paired pediatric kidneys initially had better renal function (63.9 +/- 21.4 mL/min) than those receiving single pediatric kidneys (38.2 +/- 11.6 mL/min) (p = 0.004), but by 6 months, no significant difference existed. At 2 years, renal function in the pediatric-donor group remained significantly better than in the adult-donor group. Hematocrit levels as a measure of erythropoiesis were similar for single pediatric, paired pediatric, and adult-donor recipients.
Kidneys from cadaveric donors < or = 5 years of age are suitable for transplantation into adults. Pediatric kidneys provide excellent renal function despite an initially tremendous disparity between renal mass and recipient body mass. Rapid true renal growth probably occurs. No appreciable advantage is achieved by using two pediatric kidneys for a single recipient.</description><subject>Actuarial Analysis</subject><subject>Adolescent</subject><subject>Adult</subject><subject>Biological and medical sciences</subject><subject>Cadaver</subject><subject>Child, Preschool</subject><subject>Creatinine - metabolism</subject><subject>Graft Survival</subject><subject>Hematocrit</subject><subject>Humans</subject><subject>Kidney - physiopathology</subject><subject>Kidney Transplantation - methods</subject><subject>Kidney Transplantation - physiology</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Postoperative Complications</subject><subject>Retrospective Studies</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Surgery of the urinary system</subject><subject>Transplantation, Homologous</subject><issn>1072-7515</issn><issn>1879-1190</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1997</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkE1v1DAQhi0EKmXhJ1SKEEJwSDt2En8cUQUt0ko9dO_WrD1GLlkntZND_z1uu-2B01h6n3fkeRg743DOgcuLWw5KtGrgwzejv2sA0bfwhp1yrUzLuYG39f2CvGcfSrkD4AqMPGEnphs0aHnKtruMqcwjpgWXOKVmCk2J6c9IDSbfzBgz1UE-4pKja_5Gn-ihNDEtU4N-HZcmk4tzpLSUj-xdwLHQp-PcsN2vn7vL63Z7c_X78se2dZ2EpSWBSmnke63lYIwnKQyQ1EhIwvchuN6jkKLrnfGhN11Qg8R9cM7omnYb9vV57Zyn-5XKYg-xOBrrETStxSrTaSlrb8M-_wfeTWtO9WtWcM4V11xXaHiGXJ5KyRTsnOMB84PlYB9N2yfT9lGjNdo-mbZQe2fH5ev-QP61dVRb8y_HHIvDMVTPLpZXTIDUBrruH9Smhs4</recordid><startdate>19971101</startdate><enddate>19971101</enddate><creator>RATNER, L. E</creator><creator>CIGARROA, F. G</creator><creator>BENDER, J. S</creator><creator>MAGNUSON, T</creator><creator>KRAUS, E. S</creator><general>Elsevier Science</general><general>American College of Surgeons</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>19971101</creationdate><title>Transplantation of single and paired pediatric kidneys into adult recipients</title><author>RATNER, L. E ; CIGARROA, F. G ; BENDER, J. S ; MAGNUSON, T ; KRAUS, E. S</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c360t-e2a778a1b886599de6290e68aeae2d4ffc4da26234c9df493f756abfcc984ff3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1997</creationdate><topic>Actuarial Analysis</topic><topic>Adolescent</topic><topic>Adult</topic><topic>Biological and medical sciences</topic><topic>Cadaver</topic><topic>Child, Preschool</topic><topic>Creatinine - metabolism</topic><topic>Graft Survival</topic><topic>Hematocrit</topic><topic>Humans</topic><topic>Kidney - physiopathology</topic><topic>Kidney Transplantation - methods</topic><topic>Kidney Transplantation - physiology</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Postoperative Complications</topic><topic>Retrospective Studies</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Surgery of the urinary system</topic><topic>Transplantation, Homologous</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>RATNER, L. E</creatorcontrib><creatorcontrib>CIGARROA, F. G</creatorcontrib><creatorcontrib>BENDER, J. S</creatorcontrib><creatorcontrib>MAGNUSON, T</creatorcontrib><creatorcontrib>KRAUS, E. S</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of the American College of Surgeons</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>RATNER, L. E</au><au>CIGARROA, F. G</au><au>BENDER, J. S</au><au>MAGNUSON, T</au><au>KRAUS, E. S</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Transplantation of single and paired pediatric kidneys into adult recipients</atitle><jtitle>Journal of the American College of Surgeons</jtitle><addtitle>J Am Coll Surg</addtitle><date>1997-11-01</date><risdate>1997</risdate><volume>185</volume><issue>5</issue><spage>437</spage><epage>445</epage><pages>437-445</pages><issn>1072-7515</issn><eissn>1879-1190</eissn><abstract>The transplantation of kidneys from cadaveric donors < or = 5 years of age into adult recipients is controversial. The large disparity between donor renal mass and recipient body mass is feared to be problematic. Controversy also exists whether to transplant kidneys from these young donors individually or as a pair into a single recipient.
We retrospectively reviewed our experience from January 1991 to January 1995 with 22 adult renal transplantations using kidneys from cadaveric donors < or = 5 years of age. Ten patients received single allografts. Twelve received organs paired en bloc. Fifty-two adult recipients from cadaveric donors aged 18-55 years served as controls. All patients received cyclosporine-based immunosuppression. Recipient characteristics did not differ significantly between the groups.
Actuarial patient and graft survival rates were similar for the two groups. The incidence of urinary complications was higher in the recipients of pediatric kidneys than in the adult-donor group (18.2% versus 3.8%, respectively, p = not significant). No grafts were lost from urinary complications. Renal function, as determined by the calculated creatinine clearance, was significantly greater in the pediatric group (76.1 +/- 4.0 versus 61.4 +/- 23.2 mL/min, p = 0.035) by 6 months after transplantation. Recipients of paired pediatric kidneys initially had better renal function (63.9 +/- 21.4 mL/min) than those receiving single pediatric kidneys (38.2 +/- 11.6 mL/min) (p = 0.004), but by 6 months, no significant difference existed. At 2 years, renal function in the pediatric-donor group remained significantly better than in the adult-donor group. Hematocrit levels as a measure of erythropoiesis were similar for single pediatric, paired pediatric, and adult-donor recipients.
Kidneys from cadaveric donors < or = 5 years of age are suitable for transplantation into adults. Pediatric kidneys provide excellent renal function despite an initially tremendous disparity between renal mass and recipient body mass. Rapid true renal growth probably occurs. No appreciable advantage is achieved by using two pediatric kidneys for a single recipient.</abstract><cop>New York, NY</cop><pub>Elsevier Science</pub><pmid>9358086</pmid><doi>10.1016/S1072-7515(98)80024-0</doi><tpages>9</tpages></addata></record> |
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| subjects | Actuarial Analysis Adolescent Adult Biological and medical sciences Cadaver Child, Preschool Creatinine - metabolism Graft Survival Hematocrit Humans Kidney - physiopathology Kidney Transplantation - methods Kidney Transplantation - physiology Medical sciences Middle Aged Postoperative Complications Retrospective Studies Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Surgery of the urinary system Transplantation, Homologous |
| title | Transplantation of single and paired pediatric kidneys into adult recipients |
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