Does Acute Kidney Injury Contraindicate Transplantation of Kidneys from very Small Pediatric Donors? Single-center Analysis of 68 en Bloc Kidney Transplants from Donors ≤15 kg

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Abstract

Background

Kidneys from very small pediatric donors that have acute kidney injury (AKI) are frequently discarded due to concerns about the potentially negative effects of the AKI on short- and long-term outcomes. We tested the hypothesis that AKI does not adversely impact outcomes of en bloc kidney grafts from very small donors.

Patients and Methods

We defined AKI as terminal donor creatinine [mg/dL] ≥1.5 for donors 0-14 days old and ≥1.0 for donors >14 days old. Among 219 pediatric en bloc kidney transplants from donors ≤15 kg performed 11/2003-01/2015 at our institution, we identified 29 AKI grafts and pair-matched these (for donor weight, DCD setting [7%], and preservation time) with 29 no-AKI grafts (median overall recipient age, 50.3 [7-76] years). Our standard management protocol for en bloc grafts includes hypothermic pulsatile perfusion pre-implantation, rATG induction, and steroid-free maintenance with tacrolimus and mycophenolate mofetil.

Results

Donor and preservation characteristics are given in Table 1.

Results

Delayed graft function (dialysis during the first week posttransplant) was more frequent in AKI (48%) vs. no-AKI (14%) grafts (p=0.01). Early graft loss from graft thrombosis or primary non-function occurred for 3 (10%) AKI vs. 2 (7%) no-AKI grafts (p=n.s.).

Results

At 1 and 5 years, neither death-censored graft survival (Figure 1) nor graft function (Table 2) were significantly affected by donor AKI.

Conclusions

Despite the slower early function in the AKI group, long-term survival and function of en bloc grafts from small (≤15 kg) donors were were not impacted by donor AKI. Our outcomes suggest (i) that AKI in small pediatric donors should not be viewed as a contraindication to organ donation and (ii) that these donors can effectively expand the limited deceased organ donor pool.

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