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ORIGINAL RESEARCH article
Front. Pediatr.
Sec. Pediatric Nephrology
Volume 13 - 2025 | doi: 10.3389/fped.2025.1570489
This article is part of the Research TopicChallenges and Outcomes in Pediatric and Adult Kidney TransplantsView all articles
EN-BLOC KIDNEY TRANSPLANTS FROM VERY SMALL PEDIATRIC DONORS: A PROPENSITY SCORE MATCHED ANALYSIS
Provisionally accepted
Silvia Oberparleiter1
Felix Julius Krendl1
Thomas Resch1
Rupert Oberhuber1
Hannah Esser1
Florian Ponholzer1
Annemarie Weissenbacher1Robert Breitkopf2Hannes Neuwirt3
Stefan Schneeberger1
Manuel Maglione1*
Benno Cardini1- 1Department of Visceral, Transplantation and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
- 2Department of Anesthesiology and Intensive Care, Medical University of Innsbruck, Innsbruck, Austria
- 3Department of Internal Medicine IV, Nephrology and Hypertension, Medical University of Innsbruck, Innsbruck, Austria
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Kidneys from brain-death small pediatric donors ≤2 years are still classified as marginal organs. Herein, we analyse the outcomes following en-bloc kidney transplantation (EBKT) from pediatric donors ≤2 years into adult recipients compared to standard criteria donor kidney transplant recipients (SKTs). A retrospective single center analysis of a prospectively collected and auditable database identified six EBKTs and 75 SKTs between January 2015 and June 2017. Propensity score matching minimized selection bias. After a median follow-up of 74 months, five-year patient and graft survival were 100%, each in the EBKTs group. Following SKTs, the five-year patient survival rate was 94.7%, likewise death-censored graft survival reached 94.7%. Two EBKT cases experienced unilateral arterial graft thrombosis requiring unilateral nephrectomy, with full recovery and good kidney function. At hospital discharge, recipients of EBKTs showed decreased eGFR compared to SKTs, however, from 3 months onward this reversed and following a median follow-up of 74 months the median eGFR was twice as high after EBKT compared to SKT (107ml/min/1.73m 2 vs. 52 ml/min/1.73m 2 , p<0.001).These favourable results persist in the PSM analysis. EBKTs from very small pediatric donors show excellent long-term kidney function. The higher incidence of postoperative complications does not translate into poorer mid-term patient and graft survival.
Keywords: Kidney Transplantation, Long-term outcome, Marginal organs, Postoperative Complications, Pediatric donors
Received: 03 Feb 2025; Accepted: 03 Apr 2025.
Copyright: © 2025 Oberparleiter, Krendl, Resch, Oberhuber, Esser, Ponholzer, Weissenbacher, Breitkopf, Neuwirt, Schneeberger, Maglione and Cardini. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Manuel Maglione, Department of Visceral, Transplantation and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
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