Long-term outcomes of single paediatric vs. ideal adult renal allograft transplants in adult recipients

Aim: To compare the outcomes of single paediatric vs. adult kidneys transplanted into adult recipients, Methods: A retrospective single-centre review of 38 single cadaver kidney transplants from donors less than five yr of age to wait-listed patients of low body mass index (BMI). Survival of grafts and quality of renal function were compared with 121 similarly low BMI recipients of grafts from donors 18-45 yr of age that were transplanted during the same period. Immunosuppression consisted of sirolimus, minimal-dose cyclosporine and prednisone. The mean age of the paediatric vs. adult donors was 2.8 ± 1.0 and 31.1 ± 9.2 yr, respectively (p < 0.01) and of the recipients, 42.0 ± 12.4 and 45.7 ± 14.8 yr, respectively (p = NS). The mean BMI of paediatric vs. adult donor kidney recipients was 21.8 ± 2.9 and 22.4 ± 2.0 kg/m2 (p = NS). Sixty-six per cent of paediatric donor recipients were women compared with 44% of adult donor recipients (p = 0.03). Results: Death censored actuarial graft survivals at one and five yr for recipients of paediatric vs. adult donor grafts were 93 and 84% compared with 93 and 85% (p = NS). There were no graft losses because of technical complications in the paediatric kidney donor group. At one and five yr post-transplantation, the mean estimated creatinine clearances of the paediatric donor graft recipients were 52.9 ± 19.6 and 54.0 ± 17.8 mL/min, respectively, compared with 56.4 ± 19.8 and 49.1 ± 21.7 mL/min for recipients of adult donor grafts at the same times (p = NS). Conclusion: Transplantation of single paediatric donor kidneys into low BMI adult recipients provided equivalent outcomes to those of grafts from adult donors between the ages of 18 and 45 yr.