Sureshkumar K K, Patel A A, Arora S, Marcus R J
Division of Nephrology and Hypertension, Allegheny General Hospital, Pittsburgh PA 15212, USA.
Transplant Proc. 2010 Nov;42(9):3521-3. doi: 10.1016/j.transproceed.2010.08.038.
Traditionally, kidneys from donors ≥60 years old and pediatric kidneys are considered marginal organs for transplantation. Pediatric donor kidneys are underutilized for transplantation into adult recipients due to concern for poor outcomes.
Using data from the Organ Procurement and Transplant Network, we analyzed patterns of pediatric kidney use (single vs en bloc) in the United States from 1987 to 2007. Using the Cox proportional hazards model, graft outcomes of pediatric donor kidneys transplanted as single vs en bloc grafts from different donor weight groups were compared with renal transplantation from donors ≥60 years old in an attempt to define a pediatric donor weight at which kidneys can be justifiably split to expand the donor pool.
Compared with older donor kidneys, graft failure risk of pediatric single kidneys was consistently lower when the donor weight exceeded 10 kg. On the other hand, graft survival benefit for pediatric en bloc kidneys was evident starting at donor weight ≤10 kg in comparison to older donor kidneys. Pediatric en bloc kidneys performed consistently better than pediatric single kidneys for all donor weight groups.
Splitting of pediatric donor en bloc kidneys for transplantation into 2 adults when the donor weight exceeds 10 kg was associated with acceptable graft outcomes. This practice, along with increased use of small pediatric donor kidneys, may help to alleviate the waiting list burden in renal transplantation.
传统上，60岁及以上供体的肾脏以及儿科肾脏被视为移植的边缘器官。由于担心预后不佳，儿科供体肾脏在移植给成年受者方面未得到充分利用。
利用器官获取与移植网络的数据，我们分析了1987年至2007年美国儿科肾脏的使用模式（单个移植与整块移植）。使用Cox比例风险模型，比较了不同供体体重组中作为单个移植与整块移植的儿科供体肾脏的移植结果与60岁及以上供体的肾移植结果，试图确定一个儿科供体体重，在此体重下肾脏可以合理分割以扩大供体库。
与老年供体肾脏相比，当供体体重超过10kg时，儿科单个肾脏的移植失败风险始终较低。另一方面，与老年供体肾脏相比，儿科整块肾脏的移植存活获益在供体体重≤10kg时就很明显。在所有供体体重组中，儿科整块肾脏的表现始终优于儿科单个肾脏。
当供体体重超过10kg时，将儿科供体整块肾脏分割用于移植给2名成年人，其移植结果是可以接受的。这种做法，以及增加对小儿科供体肾脏的使用，可能有助于减轻肾移植等待名单的负担。
