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Introduction Since the implementation of the new selection criteria in 2018, kidney donations from pediatric patients have been prioritized for pediatric recipients and kidney donations from pediatric donors have increased in Japan. Herein, we present two cases of en bloc kidney transplantation. Case presentation Case 1: A 19‐year‐old male patient who had been on hemodialysis for 5 years due to end‐stage renal disease. After brain death, a graft from a 5‐year‐old boy was transplanted into the right iliac fossa. Case 2: A 19‐year‐old male patient, who had previously undergone a living kidney transplantation at the age of 3, received a secondary cadaveric kidney transplantation in the left iliac fossa. The graft was procured from a 17‐month‐old girl following cardiac death. Conclusion This report will help surgeons perform en bloc kidney transplantation in the growing number of pediatric kidney donations, such as those in Japan.

Objective To evaluate the effect of hematopoietic stem cell mobilization and collection in healthy pediatric donors. Methods 67 healthy pediatric donors were included in this study.According to the donor/recipient （D/R） body weight ratio （BWR）， they were divided into three groups： D/R BWR2 group （n = 14）. The mobilization， collection effect and adverse reactions of bone marrow and peripheral blood stem cells were compared among all groups. Results The quantity of mononuclear cells （MNCs） of bone marrow stem cells collected in the D/R BWR2 group （both P < 0.001）. There was no significant difference in the quantity of bone marrow CD34+ cells among three groups （all P > 0.05）. The quantity of MNCs of peripheral blood stem cells in the D/R BWR>2 group was significantly higher than those in the D/R BWR2 group was significantly higher than that in the D/R BWR

Background: Renal transplantation is facing a shortage of grafts. En bloc kidney transplantation (EBKT) from pediatric donors could increase the number of available grafts. Objective: To describe the surgical technique as well as the long-term functional and morphological results of EBKT. Design, setting, and participants: We performed a retrospective study of all the EBKT procedures performed in Lyon between 2002 and 2020. Electronic medical records were checked with an analysis of demographics, and peri- and postoperative results. Outcome measurements and statistical analysis: A descriptive analysis of donor and recipient characteristics, perioperative data, complications, and renal function was performed. Results and limitations: Between 2002 and 2020, 21 EBKT procedures were performed. Donors had a mean weight of 8.6 kg and a mean age of 12 mo, with a mean cold ischemia time of 11 h and 30 min. Receivers had a mean age of 30 yr and a body mass index of 20. The mean follow-up time was 62 mo, with patient survival of 100% and graft survival of 95%. There were 13 reinterventions comprising one early unilateral transplantectomy for thrombosis. Renal function was excellent, and the morphological findings described an important growth in size in the first 2 yr before attaining the adult size. This study’s limitations include its retrospective nature and a small number of participants. Conclusions: The present study reports excellent results with EBKT and supports the pursuit and spread of this technique. Patient summary: In this report, we describe the technique and results of en bloc kidney transplantation. We found that results are excellent for renal function and patient survival. We conclude that en bloc kidney transplantation should be considered to increase the number of grafts.

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BackgroundEarly onset de novo focal segmental glomerular sclerosis (FSGS) in the kidney allograft in patients without FSGS in the native kidney is a rare disorder in children. It usually occurs mostly beyond the first year after kidney transplantation and often leads to graft loss. Standardized treatment protocols have not yet been established.Case descriptionWe describe a boy with early onset de novo FSGS in the transplanted kidney and non-selective glomerular proteinuria (maximum albumin-to-creatinine ratio of 3.8 g/g; normal range, ≤0.03 g/g creatinine). Manifestation occurred at 30 days posttransplant and was accompanied by a significant graft dysfunction (eGFR 61 ml/min per 1.73 m2). Treatment with 25 sessions of plasmapheresis over 14 weeks and three consecutive days of methylprednisolone pulse therapy (10 mg/kg per day) followed by oral prednisolone as rejection prophylaxis (3.73 mg/m2 per day) led to sustained remission of proteinuria (albumin-to-creatinine ratio of 0.028 g/g) and normalization of graft function (eGFR 92 ml/min per 1.73 m2) after 14 weeks. The follow-up period was 36 months.ConclusionsThis case underlines the efficacy of immunosuppressive and antibody eliminating therapy in early onset de novo FSGS after kidney transplantation.

Few transplant programs use kidneys from donors with body weight (BW)<10 kg due to higher incidence of vascular and urological complications, and DGF. The purpose of this study was to investigate the non-inferiority of pediatric en bloc kidneys from donors with BW<10 kg. We performed a single-center retrospective analysis of en bloc kidney transplants from pediatric donor cohort (n = 46) from 2003 to 2021 and stratified the outcomes by donor BW (small group, donor BW<10 kg, n = 30; standard group, donor BW<10 kg, n = 16). Graft function, rate of early post-transplant complications, graft and patient survival were analyzed. Complication rates were similar between both groups with 1 case of arterial thrombosis in the smaller group. Overall graft and patient survival rates were similar between the small and the standard group (graft survival—90% vs. 100%, p = 0.09; patient survival—96.7 vs. 100%, p = 0.48). Serum creatinine at 1, 3, 5 years was no different between groups. Reoperation rate was higher in the small group (23.3% vs. 6.25%, p = 0.03). The allograft from small donors could be related to higher reoperation rate in the early post-transplant period, but not associated with lower long-term graft and patient survival. [ABSTRACT FROM AUTHOR]

Objective To summarize the clinical outcomes of en-bloc kidney transplantation (EBKT) from pediatric donors at a single center and summarize the experiences and lessons. Methods Thirty-six pediatric to adult EBKTs were performed between July 2011 and February 2022.The primary outcome variable was en-bloc allograft survival rate. Secondary outcome variables included incidence of graft failure and incidence of urological complications. The postoperative occurrences of such complications as proteinuria and hemorrhage were recorded along with overall survival and serum creatinine during 3-year follow-ups. Results Both 1/3-year graft survival rates were 83%(30/36) and the recipient survival rate was 100%(36/36).And 30 recipients achieved long-term graft survival. Improvement of creatinine level was noted up until the third year. Graft failure was a serious posttransplant complication with an incidence of 16.7%(6/36).Other complications included urological complications (16.7%, 6/36) and hemorrhage (11.1%, 4/36).The percentage of patients with proteinuria declined gradually and proteinuria subsided largely during follow-ups. Conclusion EBKT from pediatric donors is associated with excellent long-term allograft and patient survivals. It is a feasible strategy of expanding the transplant donor pool. [ABSTRACT FROM AUTHOR]

Background: The organ shortage is the main concern for kidney transplantation. Using deceased pediatric donors either as single or in an en-bloc manner is one way to solve this problem. We reviewed 21 en-bloc pediatric deceased kidney transplantations to adult recipients. Methods: From May 2010 to May 2016, 472 deceased kidney transplantations have been performed in our hospitals. Twenty-one of these were pediatric kidney transplantations to adult recipients (age < 5 years, kidney size < 8 cm, donor weight <15 kg). Follow-up (ranging from 3 to 36 months) included clinical findings and complications plus serial creatinine levels and kidney size with ultrasonography and dimercaptosuccinic acid renal scan. Results: Among 21 patients, 52.4% were female. The mean age of participants was 28.85 ± 10.29 years. The preoperative mean size of the grafts was 6.94 ± 0.58 centimeters reaching 8.52 ± 0.98 and 10.20 ± 1.2 after 3 and 12 months of postoperative follow-up, respectively (P-value < 0.001). Means of serum creatinine was 1.61 ± 0.39, 1.45 ± 0.39, 1.32 ± 0.37, and 1.17 ± 0.28 mg/dl at postoperative 1, 3, and 6 and 12 months, respectively (P-value < 0.001). In a 12-month follow-up (range, 3 to 36 months), the complication-free rate was 61.9%, one-year patient survival was 90.5%, and one-year graft survival was 100%. Conclusion: En-bloc pediatric deceased kidney transplantation is an acceptable alternative for adult recipients, with a great midterm patient and graft survival. Longer follow-up is recommended to assess their long-term outcomes. [ABSTRACT FROM AUTHOR]

Background: Pediatric deceased donors offer great potential for expanding the organ donor pool. The utilization of pediatric donor kidneys has been explored by numerous transplant centers; however, the transplant outcome and risk factors have not been well elucidated. The aim of this study was to demonstrate the safety and risk factors of transplant outcome from pediatric deceased donors., Methods: We retrospectively analyzed 484 cases of single kidney transplantation (SKT) with pediatric donor kidneys performed at our center from January 2012 to March 2021. The recipients were grouped by age: child (≤12 years; n=143), adolescents (12-18 years; n=86), and adults (≥18 years; n=255). The overall prognosis of the recipients was analyzed, and the post-transplant outcomes were compared among the three groups and assessed by univariate and multivariate analyses using the Cox proportional risk model., Results: The median follow-up time was 26.7 months. The 1- and 3-year patient survival rates were 98.7% and 96.8%, respectively. The 1- and 3-year death-censored graft survival (DCGS) was 96.1% and 92.7%, respectively. The overall estimated glomerular filtration rates (eGFRs) at 1 and 3 years were 80.0±24.5 and 84.2±25.2 mL/min/1.73 m 2 ; the 3-year eGFR of the three groups were comparable and all were over 80 mL/min/1.73 m 2 . Rejection was an independent risk factor for death-censored graft failure within 3 years after transplantation [hazard ratio (HR) =3.85; P=0.001], and was the primary cause of graft losses in the adolescent group. Thrombosis was more common within 1-month post-transplant in the child recipients (P<0.05), and its incidence was higher in recipients with donor body weight (DBW) ≤11 kg., Conclusions: SKT from pediatric donors could achieve decent outcomes. Rejection was an independent risk factor of graft survival, especially for adolescent recipients. Child recipients may compromise early transplant outcomes due to vascular thrombosis, which might be related to small (DBW ≤11 kg) pediatric donors., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://tp.amegroups.com/article/view/10.21037/tp-22-547/coif). The authors have no conflicts of interest to declare., (2022 Translational Pediatrics. All rights reserved.)

Background and Objectives: En bloc kidney transplantation (EBKT) from pediatric donors into adult recipients increases the donor pool. However, this surgical procedure is not widely performed in many transplant centers. To evaluate the long-term outcomes of EBKT from pediatric donors into adult recipients in a single center., Material and Methods: Retrospective analysis of 42 patients who received pediatric cadaveric EBKT in our center since 1999. Median follow-up period was 73 months (5-233) in which renal function tests were taken and complications registered., Results: We have performed 42 EBKT from pediatric donors into adult recipients in our center. The recipients' age was 44.1 ± 11.8 years. Pediatric donors were 22.4 ± 14.7 months old and weighted 11.3 ± 3.6 kg. Cold ischemia time was 15.7 ± 4.5 h. During a median follow-up of 73 months, 35 patients (83.3%) had graft survival with excellent function (first-year serum creatinine levels of 0.99 ± 0.25 mg/dl). There were seven graft losses (16.7%) in the immediate postoperative period (four cases of vascular thrombosis, one anastomosis dehiscence and two cortical necrosis)., Conclusions: The pediatric en bloc renal graft transplantation into adults is a safe technique with excellent medium- to long-term functional performance. The vast majority of significant complications leading to graft loss were reported in the immediate postoperative period. A good selection of donors and recipients as well as an adequate surgical technique are essential to minimize the occurrence of adverse events., (Copyright © 2021 AEU. Published by Elsevier España, S.L.U. All rights reserved.)