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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 : We investigated the incidence and outcomes of pediatric deceased donor liver transplantation (DDLT) using whole liver grafts in a high-volume liver transplantation (LT) center. Methods : The study was a retrospective single-center analysis of whole LT in pediatric recipients. The study period was set as 20 years between January 2000 and December 2019. We defined pediatric recipients and donors to be aged ≤18 years. Results : During the study period, there were 98 cases of pediatric DDLT, and 34 patients (34.7%) received whole liver grafts. The age range of the deceased donors was 3 months to 56 years and that of pediatric recipients was 7 months to 17 years. Common primary diseases for LT were biliary atresia in 13, acute liver failure in four, Wilson disease in four, congenital portal vein agenesis in three, and genetic metabolic diseases in three. Pediatric-to-pediatric and adult-to-pediatric whole LTs were 22 (64.7%) and 12 (35.3%), respectively. A good correlation was noted between the donor and the recipient’s body weight, and the recipient’s body weight and allograft’s weight. Graft and overall patient survival rates were 91.2% and 91.2% at 1 year, 88.0% and 88.0% at 3 years, and 88.0% and 88.0% at 5 years, respectively. Conclusions: The results of this study revealed that Korean Network for Organ Sharing (KONOS) regulations with donor-recipient body weight matching exhibited good performance. Considering the reciprocal trades of liver organs among pediatric and adult donors and recipients, it is necessary to establish a policy for pediatric donor liver grafts to pediatric recipients on a priority basis.

Background : The present study intended to investigate the allocation status of pediatric deceased donor liver allografts. We analyzed the incidence of pediatric deceased donors in the Korean Network for Organ Sharing (KONOS) database and single-institutional status of liver transplantation (LT) using pediatric donors. Methods : We assessed the nationwide incidence of pediatric donors aged ≤15 years and conducted single-center analysis of LT using pediatric donors. Results : Between 2010 and 2019, pediatric donors aged ≤15 years accounted for 171 out of 4,395 donors (3.9%) in the KONOS database and 31 out of 640 liver donors (4.8%) in Asan Medical Center (AMC) database. In AMC, 11 (35.5%) and 20 (64.5%) grafts were allocated to pediatric recipients aged ≤15 years and adult recipients aged ≥19 years, respectively. All nine livers from donors aged ≤5 years were implanted in pediatric recipients aged ≤5 years. From 21 donors aged ≥9 years, 16 whole liver grafts and four split extended right liver grafts were implanted in 20 adult recipients and two split left lateral section grafts were implanted in two pediatric recipients. Four split liver grafts were implanted in other institutions. The overall patient survival rates at 1, 3, and 5 years were 90.9%, 80.8%, and 80.8%, respectively in pediatric-to-pediatric LT group and 69.6%, 58.4%, and 58.4%, respectively in pediatric-to-adult LT group (P=0.21). Conclusions: More than half of the pediatric donor livers were allocated to adult patients. Recipient criteria for allocation of liver allografts from pediatric donors need revision for children on pediatric LT waitlist.

Abstract Background Access to kidney transplantation by uremic children is very limited due to the lack of donors in many countries. We sought to explore small pediatric kidney donors as a strategy to provide transplant opportunities for uremic children. Methods A total of 56 cases of single pediatric kidney transplantation and 26 cases of en bloc kidney transplantation from pediatric donors with body weight (BW) less than 10 kg were performed in two transplant centers in China and the transplant outcomes were retrospectively analyzed. Results The 1-year and 2-year death-censored graft survival in the en bloc kidney transplantation (KTx) group was inferior to that in the single KTx group. Subgroup analysis of the single KTx group found that the 1-year and 2-year death-censored graft survival in the group where the donor BW was between 5 and 10 kg was 97.7 and 90.0%, respectively. However, graft survival was significantly decreased when donor BW was ≤5 kg (p

Background: Donor-derived cell-free DNA (ddcfDNA) has been suggested as an indicator of allograft injury in adult and pediatric kidney transplantation (KTx). However, the dynamics of ddcfDNA in pediatric KTx have not been investigated. In addition, it has not been demonstrated whether donor-recipient (D/R) size mismatch affect ddcfDNA level.Methods: Pediatric KTx recipients with a single donor kidney were enrolled and followed up for 1 year. ddcfDNA, calculated as a fraction (%) in the recipient plasma, was examined longitudinally within 3 months post-transplant. D/R size mismatch degree was described as D/R height ratio. The 33rd percentile of D/R height ratio (0.70) was used as the cut-off to divide the patients into low donor-recipient height ratio group (30% from stable value with a peak value >1% during elevation.Results: Twenty-one clinically stable recipients were enrolled. The median D/R height ratio was 0.83 (0.62–0.88). It took a median of 8 days for ddcfDNA to drop from day 1 and reach a stable value of 0.67% (0.46–0.73%). Nevertheless, 61.5% patients presented ddcfDNA>1% at day 30. Besides, 81.0% (17/21) of patients experienced elevated ddcfDNA and 47.6% (10/21) met the standard of ddcfDNA flare-up. Donor-recipient height ratio was an independent risk factor for ddcfDNA flare-up (odds ratio = 0.469 per 0.1, 95% CI 0.237–0.925, p = 0.029) and low donor-recipient height ratio (

BackgroundKidney transplantation from donors who weigh ≤5 kg is performed at only a few transplant centers owing to the high complication and low graft survival rates associated with this approach.MethodsWe retrospectively compared the results of kidney transplantation at our center between January 2015 and December 2019 based on the following pediatric donor criteria: donor body weight ≤5 kg (n=32), 5 kg< donor weight ≤20 kg (n=143), and donor weight >20 kg (n=110). We also perform subgroup analysis of kidney transplantation outcomes from ≤5 kg donors, using conventional (dual separate and classic en-bloc KTx)/novel (en-bloc KTx with outflow tract) surgical methods and allocating to adult/pediatric recipients.ResultsThe death-censored graft survival rates from extremely low body weight ≤5kg at 1 month, and 1, 3, and 5 years were 90.6%, 80.9%, 77.5%, and 73.9%, respectively, which were significantly lower than that from larger body weight pediatric donors. However, the 3-, and 5-year post-transplantation eGFRs were not significantly different between the pediatric and adult recipient group. The thrombosis (18.8%) and urinary leakage (18.8%) rates were significantly higher in the donor weight ≤5 kg group. Compared with 5 kg< donor weight ≤20 kg group, donor weight ≤5kg group was at elevated risk of graft loss due to thrombosis (OR: 13.4) and acute rejection (OR: 6.7). No significant difference on the outcomes of extremely low body weight donor kidney transplantation was observed between adults and pediatric recipients. Urinary leakage rate is significantly lower in the novel operation (8.7%) than in the conventional operation group (44.4%).ConclusionsAlthough the outcomes of donor body weight ≤5kg kidney transplantation is inferior to that from donors with large body weight, it can be improved through technical improvement. Donors with body weight ≤5 kg can be considered as an useful source to expand the donor pool.

Background: Kidney transplantation from donors who weigh ≤5 kg is performed at only a few transplant centers owing to the high complication and low graft survival rates associated with this approach. Methods: We retrospectively compared the results of kidney transplantation at our center between January 2015 and December 2019 based on the following pediatric donor criteria: donor body weight ≤5 kg (n=32), 5 kg< donor weight ≤20 kg (n=143), and donor weight >20 kg (n=110). We also perform subgroup analysis of kidney transplantation outcomes from ≤5 kg donors, using conventional (dual separate and classic en-bloc KTx)/novel (en-bloc KTx with outflow tract) surgical methods and allocating to adult/pediatric recipients. Results: The death-censored graft survival rates from extremely low body weight ≤5kg at 1 month, and 1, 3, and 5 years were 90.6%, 80.9%, 77.5%, and 73.9%, respectively, which were significantly lower than that from larger body weight pediatric donors. However, the 3-, and 5-year post-transplantation eGFRs were not significantly different between the pediatric and adult recipient group. The thrombosis (18.8%) and urinary leakage (18.8%) rates were significantly higher in the donor weight ≤5 kg group. Compared with 5 kg< donor weight ≤20 kg group, donor weight ≤5kg group was at elevated risk of graft loss due to thrombosis (OR: 13.4) and acute rejection (OR: 6.7). No significant difference on the outcomes of extremely low body weight donor kidney transplantation was observed between adults and pediatric recipients. Urinary leakage rate is significantly lower in the novel operation (8.7%) than in the conventional operation group (44.4%). Conclusions: Although the outcomes of donor body weight ≤5kg kidney transplantation is inferior to that from donors with large body weight, it can be improved through technical improvement. Donors with body weight ≤5 kg can be considered as an useful source to expand the donor pool. [ABSTRACT FROM AUTHOR]

Despite good organ quality, pancreata from extremely small pediatric donors (<30 kg) are generally avoided by many centers because of concerns of reduced islet cell mass and early technical failure. Therefore, we sought to compare the outcomes of small pancreas grafts (<30 kg) to those from higher weight donors from transplants performed between 1994 and 2015 (n = 1183). A total of 33 pancreata were from donors' ≤30 kg (3%), with a mean weight of 23.8 kg and mean age of 7.8 years. Patient survival was similar at 1, 5, and 10 years between recipients of ≤30 and >30 kg donors (≤30 kg: 96.8%, 86.8%, and 78.1% vs. >30 kg: 96.8%, 89.5%, and 79.1%, P = 0.5). Pancreas graft survival at 1, 5, and 10 years was also similar, ≤30 kg: 93.9%, 73.2%, and 61.0% vs. >30 kg: 87%, 73.3%, and 58.3% (P = 0.7). This graft survival pattern was also seen when comparing pancreata from ≤20 kg donors to those from >20 to 30 kg. Cause of graft loss, and metabolic and physiologic outcomes did not differ between the groups. After assessing the impact of donor weight as a continuous variable and calculating recipient‐to‐donor weight ratio (RDWR), we observed no effect of donor weight on patient and graft outcomes. [ABSTRACT FROM AUTHOR]

Background: Access to kidney transplantation by uremic children is very limited due to the lack of donors in many countries. We sought to explore small pediatric kidney donors as a strategy to provide transplant opportunities for uremic children.Methods: A total of 56 cases of single pediatric kidney transplantation and 26 cases of en bloc kidney transplantation from pediatric donors with body weight (BW) less than 10 kg were performed in two transplant centers in China and the transplant outcomes were retrospectively analyzed.Results: The 1-year and 2-year death-censored graft survival in the en bloc kidney transplantation (KTx) group was inferior to that in the single KTx group. Subgroup analysis of the single KTx group found that the 1-year and 2-year death-censored graft survival in the group where the donor BW was between 5 and 10 kg was 97.7 and 90.0%, respectively. However, graft survival was significantly decreased when donor BW was ≤5 kg (p < 0.01), mainly because of the higher rate of thrombosis (p = 0.035). In the single KTx group, the graft length was increased from 6.7 cm at day 7 to 10.5 cm at 36 months posttransplant. The estimated glomerular filtration rate increased up to 24 months posttransplant. Delayed graft function and urethral complications were more common in the group with BW was ≤5 kg.Conclusions: Our study suggests that single kidney transplantation from donors weighing over 5 kg to pediatric recipients is a feasible option for children with poor access to transplantation. [ABSTRACT FROM AUTHOR]

The huge disparity between the number of end-stage renal disease patients awaiting renal transplant and the available donor organs can be overcome by increasing the utilization of donor organs from deceased donors. The use of kidneys from a deceased pediatric donor is technically challenging because of the smaller size of the donor organ, leading to a higher incidence of graft thrombosis apart from concerns of low nephron load resulting in early graft failure. We present a case of en-bloc kidney transplant from an 11-month-old to a 38-year-old female recipient. The cold ischemia was 250 min and operative time was 300 min. The 1st day urine output was 6.7 l with serum creatinine dropped to 0.9% mg on postoperative day 3.

The suitable size of a graft is a key element in the success of liver transplantation. A small-for-size liver graft is very likely to sustain a significant degree of injury as a result of ischemia, preservation, reperfusion, and rejection. Usually, small-for-size grafts are a concern in living-donor liver transplantation rather than in deceased-donor liver transplantation. Here, we describe the successful transplantation of a liver from a 2-year-old deceased donor to a 61-year-old male recipient who suffered from liver failure related to hepatitis B. No report of successful deceased-donor liver transplantation with discrepancies between donor and recipient age and size to such an extent has been found in the literature. Despite unusually large discrepancies, with effort in minimizing the ischemic time, revised surgical techniques, and strong regenerative power of the “young” graft, the old patient's liver function gradually returned to normal. This again proves that the definition of a “suitable graft” evolves with time and experience.

Objective: En Bloc Kidney Transplants (EBKT) from pediatric donor have been performed at Ramathibodi Hospital, Thailand since January 2014. We review and report our clinical outcome. Materials and Methods: Retrospective data records between January 2014 to December 2016, 3 cases of EBKT were performed in our hospital. The technique and outcome of EBKT were reviewed. The literature was also reviewed regarding to clinical outcome and indication for EBK. Results: 3 EBKTs were performed between 2014 to 2016. The 1 year graft survival rate was 100%. No surgical complication, delayed graft function, acute rejection episodes were found. There was neither morbidity nor mortality. Conclusion: En Bloc Kidney transplants (EBKT) in our center were safe and with excellent outcome when optimize selected criteria were optimized. EBK could improve the rate of kidney transplants in developing countries. [ABSTRACT FROM AUTHOR]

Introduction: There is a shortage of optimal pancreatic donors for simultaneous pancreas and kidney transplant (SPKT), as such there is interest in utilizing donors at extremes of age to expand the donor pool. We sought to evaluate outcomes in SPKT from pediatric donors (PDs) to older donors (ODs). Patients and Methods: We identified patients who underwent simultaneous pancreas and kidney transplant at a single, high-volume institution from 1988-2013. We evaluated for differences in transplant organ function (estimated glomerular filtration rate [GFR], serum glucose, and urine amylase), early (technical) graft loss, and patient and graft survival. Results: A total of 729 SPKT were performed during the study, with 32 PDs, 652 standard donors (SDs), and 45 ODs. Renal function was slightly worse in OD. Otherwise, graft function was similar between all three groups at up to 5 years. There was no difference in censored survival analyses for both kidney and pancreas allografts. There was comparable short-term and long-term patient survival among all groups. Conclusions: Overall, the use of pancreas from pediatric and ODs for SPKT has comparable outcome to SDs. Kidneys from donors above 50 may have lower GFR, but otherwise, have comparable long-term patient and graft survival. [ABSTRACT FROM AUTHOR]

Administration of filgrastim (recombinant human granulocyte colony-stimulating factor [rhG-CSF]) (Neupogen) in healthy donors to mobilize hematopoietic stem cells (HSCs) is a widespread practice in adults. Application of peripheral blood stem cell (PBSC) collection in normal pediatric donors is scarce due to ethical issues. Hence, there are insufficient data on the long-term impact of PBSC procedure in healthy children. This retrospective study aimed to evaluate the early and late adverse effects of PBSC donation in pediatric donors. Bone marrow and PBSC procedures and known adverse events of each technique were completely explained to parents and when applicable to children and written informed consent was obtained. rhG-CSF was administered for 4 days. HSCs were collected on the fifth day through continuous-flow apheresis and donors were followed for 30 days. Manual chart review was performed to collect short-term complications. Donors' health status was assessed via a questionnaire. A total of 145 healthy pediatric donors with a median age of 10 years at the time of donation (2 to 15 years) were followed for a median of 4.8 years (range, 1.2 to 14.2 years). The most frequent symptoms of rhG-CSF administration were fatigue (5%) and headache (3%). Thirty-five (24%) donors experienced hypocalcaemia during apheresis procedure that quickly responded to treatment. Two pregnancies occurred after rhG-CSF administration that resulted in normal births. We did not encounter any serious adverse events, including neoplastic disorders and death in this study. rhG-CSF and leukophresis procedure were well-tolerated in this study and all children completed the donation process without interruption or reduction of rhG-CSF dosage. Our results suggest that rhG-CSF is a safe drug in healthy children for the purpose of HSC mobilization. [ABSTRACT FROM AUTHOR]

The huge disparity between the number of end-stage renal disease patients awaiting renal transplant and the available donor organs can be overcome by increasing the utilization of donor organs from deceased donors. The use of kidneys from a deceased pediatric donor is technically challenging because of the smaller size of the donor organ, leading to a higher incidence of graft thrombosis apart from concerns of low nephron load resulting in early graft failure. We present a case of en-bloc kidney transplant from an 11-month-old to a 38-year-old female recipient. The cold ischemia was 250 min and operative time was 300 min. The 1st day urine output was 6.7 l with serum creatinine dropped to 0.9% mg on postoperative day 3. [ABSTRACT FROM AUTHOR]

Background Dual kidney transplantation (DKT) from small pediatric donors, either en-bloc or split dual kidney transplantation, contributes to mitigating organ scarcity. This study investigates the prognosis of DKT from pediatric deceased donors, and influencing factors.Method A retrospective study included recipients who underwent DKT from pediatric donors between 2012 and 2022. Recipients were categorized into low mismatch (BWLM, n = 30) and high mismatch (BWHM, n = 10) groups based on donor-recipient weight ratio of 1:10. Outcome encompassed recipient and graft survival, renal function, and adverse events.Result Forty recipients were included. The average follow-up period was 54.6 months. The 1, 3, and 5-year patient survival were 97.4%, with no significant differences between en-bloc and split dual kidney transplantation or between BWLM and BWHM groups. The graft survival at 1, 3, and 5 years were 89.9%, the graft survival of BWHM group was lower than BWLM group (70% vs 96.7%, p = 0.039). The average eGFR at 1, 3, and 5 years postoperatively were (78.93 ± 25.23), (83.82 ± 32.4), and (85.92 ± 37.08) mL/min/1.73 m2, respectively. The BWHM group also experienced higher rates of graft-related surgical complications (p = 0.006) and urinary tract surgical complications (p = 0.042).Conclusion DKT from pediatric donors yields favorable outcomes, with similar graft survival and complication rates across surgical subgroups. However, significant donor-recipient weight mismatch, particularly when the ratio is less than 1:10, may contribute to increased surgical complications and poorer graft survival. Efforts to minimize extreme weight mismatch are recommended to optimize outcomes.

In LT, the common policy is to allocate pediatric liver grafts to pediatric recipients. Pediatric organs are also offered to adults if there is no pediatric recipient. However, they are rarely accepted for adult recipients. So far, there is no information available reporting outcome of LT in adult recipients using pediatric livers from donors ≤6 yr. In this study, we included nine adult recipients (seven females and two males) who received grafts from children ≤6 yr from January 2008 to December 2013. We evaluated the graft quality, the GBWR and analyzed the recipients' perioperative course. Laboratory samples and graft perfusion were analyzed. Nine adults with a median age of 49 yr (range: 25-65) and a median weight of 60 kg (range: 48-64) underwent LT with a pediatric donor graft. Median donor age was five yr (range: 3-6). Median GBWR was 1.02 (range: 0.86-1.45). After a median follow-up of 3.9 yr (range: 11 months-6.6 yr), patient survival was 100%; graft survival was 89%. One patient needed re-transplantation on the second postoperative day due to PNF. Eight recipients were discharged from the ICU after 2-9 days with a regular graft function. Doppler scans revealed regular flow patterns at any time. Only if denied for pediatric recipients, the use of pediatric livers from donors ≤6 yr for adult recipients is a considerable option. [ABSTRACT FROM AUTHOR]

Summary The suitable size of a graft is a key element in the success of liver transplantation. A small-for-size liver graft is very likely to sustain a significant degree of injury as a result of ischemia, preservation, reperfusion, and rejection. Usually, small-for-size grafts are a concern in living-donor liver transplantation rather than in deceased-donor liver transplantation. Here, we describe the successful transplantation of a liver from a 2-year-old deceased donor to a 61-year-old male recipient who suffered from liver failure related to hepatitis B. No report of successful deceased-donor liver transplantation with discrepancies between donor and recipient age and size to such an extent has been found in the literature. Despite unusually large discrepancies, with effort in minimizing the ischemic time, revised surgical techniques, and strong regenerative power of the “young” graft, the old patient's liver function gradually returned to normal. This again proves that the definition of a “suitable graft” evolves with time and experience. [ABSTRACT FROM AUTHOR]

Background Kidneys from pediatric donors weighing <10 kg are preferably transplanted en bloc, while kidneys from donors weighing >15 kg can be safely transplanted as single kidneys. However, single kidney transplantation from donors weighing 10-14 kg is controversial and has not been well investigated. Methods We analyzed the outcome of 15 recipients of single kidneys from donors weighing 10-14 kg (study group) with 40 recipients receiving an allograft from ideal deceased donors (control group). Results After a follow-up of three yr, death-censored graft survival was 100% in both groups. The calculated creatinine clearance was lower in the study group at six months (53 vs. 71 mL/min; p = 0.01) and similar at 12 months (68 vs. 68 mL/min; p = 0.48), 24 months (81 vs. 70 mL/min; p = 0.58), and 36 months (74 vs. 69 mL/min; p = 0.59). Urinary albumin/creatinine ratios were comparable between the two groups up to two yr. At three yr, urinary albumin/creatinine ratios were higher in the study group than the control group (10.5 vs. 0.9 mg/mmol; p = 0.007). Surveillance biopsies at three and six months post-transplant revealed no evidence for focal segmental glomerulosclerosis in the study group. Conclusions Transplantation of single pediatric kidneys from donors weighing 10-14 kg into adult recipients provides excellent intermediate-term outcomes. Low-grade albuminuria, three yr post-transplant, might indicate late-onset hyperfiltration injury. [ABSTRACT FROM AUTHOR]

Kidneys from donors ≤5 yr of age represent a controversial issue. The purpose of this study was to compare the transplant outcomes as single and single/en bloc grafts into pediatric and adult KT recipients, respectively. All recipients of kidneys from donors ≤5 yr old transplanted at our institution from 3/2003 to 12/2010 were evaluated, and corresponding data were analyzed. There were 11 pediatric and 14 adult recipients. Median donor age and body weight were 38 months and 14 kg, respectively. PNF, n = 2 and DGF, n = 1 were observed only among adult recipients. Five-yr graft survival was 100% for children and 86% for adults. There were no significant differences in graft and patient survival, PNF, DGF, acute rejection, or postoperative complications among children/single (n = 10), adults/en bloc (n = 10), and adults/single (n = 4) KT. Major complications were documented in six adult recipients and one pediatric recipient after en bloc KT. Pediatric recipients showed significantly higher GFR during the first post-transplant year. Kidneys from donors ≤5 yr of age have at least as good outcomes as when transplanted as single allografts into children. Although the study-volume is small, it seems that children benefit from a pediatric-oriented allocation policy. [ABSTRACT FROM AUTHOR]