Researchers at UC Davis found that "en bloc" kidneys transplanted from very young deceased donors (median age 1 year) are safe and may have some advantages for children awaiting a kidney transplant.
These findings could have an important impact on clinical care, as opening up a new source of donor kidneys could shorten wait times for children who need a kidney transplant, reducing their reliance on dialysis. The study was published in The Journal of Pediatrics.
“The results would suggest that very young donor kidneys transplanted en bloc have similar outcomes to those that come from standard deceased donors,” said Erica Winnicki, assistant professor of pediatric nephrology at UC Davis and first author on the paper. “In addition, kidney function at five years after transplant was found to be superior and wait list times shorter for the recipients of en bloc kidneys.”
While en bloc transplants from very young donors are used for adults awaiting a kidney transplant at the majority of transplant centers, they are rarely considered for use in children due to concerns that these kidneys might be inferior. In particular, previous studies had shown there might be a higher risk of blood clots when very young donor kidneys were transplanted into children. However, the transplant surgery team at UC Davis has performed en bloc kidney transplants for many years with very good outcomes and decided to dive deeper into the issue.
To determine whether en bloc transplants should be considered an option for children, the researchers mined the Organ Procurement and Transplant Network (OPTN) database to find patients under 21 who had received a transplant from a deceased donor between January 1, 2000, and June 30, 2013. Live donor transplants were not included in the study.
The database produced 6,882 cases, including 6,756 who received a standard transplant and 126 who had an en bloc procedure. Children who received the en bloc transplants had much shorter wait times: 157 days versus 208 for the standard recipients. This is a significant finding, as earlier transplants may boost both height and brain development.
In addition, survival of the transplanted kidneys was similar for children who received en bloc kidneys as compared to standard deceased donor kidneys. Furthermore, children who received the en bloc kidney transplants had better kidney function at five years after transplant, as indicated by their estimated glomerular filtration rate (eGFR), a key diagnostic test.
This research could bring greater acceptance of the use of en bloc transplants for pediatric patients with kidney failure. In fact, an editorial published in the April issue of The Journal of Pediatrics encouraged transplant centers to expand their use of en bloc transplants.
"These results make me feel comfortable counseling families that this is a good option for their children," said Winnicki.
Other authors included Madan Dharmar, Daniel Tancredi and Lavjay Butani, of UC Davis.
The study was funded by Children’s Miracle Network and the Health Resources and Services Administration (234-2005-37011C).