Superior long-term graft function and better growth of grafts in children receiving kidneys from paediatric compared with adult donors

TLDR

Previous reports suggested that small kidneys from paediatric donors yield inferior graft function in children, leading to their underuse. This study compared long‑term graft function and growth in children receiving kidneys from paediatric versus adult donors. We followed 99 white children (<10 yr) who received cadaveric kidney transplants between 1990 and 2005, divided into adult‑donor (63) and paediatric‑donor (39) groups, with a mean 5.9‑year observation, and compared graft function and growth. Recipients of paediatric donor kidneys had higher GFR, doubled graft size, and comparable survival versus adult donor recipients.

Abstract

Organs from paediatric donors are often not accepted for paediatric recipients because previous reports suggested inferior graft function for small kidneys transplanted in children. On the other hand, studies have shown that kidneys of adult donors transplanted into children down-regulate filtration after transplantation and may not increase their function to the need of the growing child.We assessed 64 male and 35 female (total n = 99) white children aged <10 years (male: mean 5.1 years, SD 2.8; female: mean 5.8 years, SD 3.4) who had received cadaveric kidney transplants at our centre between 1990 and 2005. Mean observation time was 5.9 years, SD 4.0. The children were divided into two groups depending on the kidney donor age: 63 children (mean age 5.0 years, SD 2.9) received an organ of an adult, and 39 (mean age 6.4 years, SD 3.4) of a paediatric donor. Immunosuppression was performed with prednisolone, cyclosporin A microemulsion+/-mycophenolate mofetil.Three to five years after transplantation the calculated glomerular filtration rate corrected to body surface was significantly higher in recipients of paediatric organs. The size of paediatric grafts doubled in the first years after transplantation while adult grafts had a stable size. Graft survival was comparable in both groups during observation time.We conclude that paediatric donor kidneys should be given preferentially to paediatric recipients due to better long-term function.