Outcomes of children receiving en bloc renal transplants from small pediatric donors

The utilization of en bloc renal allografts from small pediatric donors has been adopted as an effective strategy to expand the organ donor pool in adult recipients. Data in children are limited. The aim of our study is to describe the outcomes of en bloc renal transplants in children from our center. Medical records of children receiving pediatric en bloc renal transplants at our institution from January 2007 were abstracted. Data collected included recipient and donor demographics, operative technique and complications, and post-operative studies. Eight children received en bloc renal transplants at a median age of 17yr; median follow-up was 0.9yr. Donor body weight ranged from 4 to 22kg. One kidney was lost to intra-operative thrombosis, while the other kidney from this en bloc graft remained viable. All grafts showed increased renal size at follow-up ultrasound. Surveillance biopsies showed glomerulomegaly in two patients. At last follow-up, the median eGFR was 130mL/min/1.73m2. The urinary protein to creatinine ratio was normal in four of seven patients. Our data suggest that in experienced centers, en bloc renal transplantation from young donors into pediatric recipients is effective. Long-term follow-up to monitor for complications, including hyperfiltration injury, is warranted.