Long-term outcome of en bloc pediatric kidney transplantation in adult recipients - up to 22 years of center experience

Background: Renal transplantation has been shown to be the best therapeutic option in end-stage renal disease patients. En bloc transplantation of pediatric kidneys into adult recipients (EBKT) is one strategy to increase the donor pool. We here report on 10 to 22 years of follow-up (median of 12.8 years) of patients receiving EBKT in a single-center, retrospective cohort study. Material/Methods: The mean donor age was 14 +/- 12 months and mean donor body weight was 8 +/- 3 kilograms. Thirteen recipients (6 females, 7 males) were followed for 10 to 22 years. The mean recipient age was 44 +/- 13 years at the time of transplantation. Results: Two of 13 patients lost their grafts in the first week because of hemorrhagic infarction of the kidney transplants or sepsis (septic shock). Only 1 patient had an acute cellular rejection, which was successfully treated with steroids and anti-CD3 antibody. Eleven out of 13 patients after EBKT survived and had a functioning graft 10 to 22 years after successful EBKT. The serum creatinine was 1.34 +/- 0.6 mg/dl at 5 years (n=11), 1.37 +/- 0.7 mg/dl at 10 years (n=11), 1.40 +/- 0.6 mg/dl at 15 years (n=4), and 1.08 mg/dl at 20 years after EBKT (n=2). The eGFR, evaluated by using MDRD-2, was 66.5 +/- 22 ml/min/m(2) at 5 years (n=11), 62 +/- 28 ml/min/m(2) at 10 years (n=11), 56 +/- 23 ml/min/m(2) at 15 years (n=4), and 61 ml/min/m(2) at 20 years after EBKT (n=2). Proteinuria did not increase significantly within the observation period. Conclusions: In our experience, if the acute post-operative phase is uncomplicated, EBKT has excellent long-term graft and patient survival.