Mayo Clinic Alix School of Medicine, Scottsdale, Arizona.
Division of Nephrology, Mayo Clinic, Phoenix, Arizona.
Transplant Proc. 2021 Jun;53(5):1509-1513. doi: 10.1016/j.transproceed.2021.03.030. Epub 2021 Apr 21.
Kidneys from very young pediatric donors continue to be underutilized. To reduce discard, the Organ Procurement and Transplantation Network (OPTN) policy was recently updated to allow kidneys from donors weighing <18 kg to be recovered en bloc.
We reviewed our center's experience with kidney transplantation in adult recipients of <18 kg pediatric donor kidneys to assess renal function outcomes specific to solitary vs en bloc usage.
The majority of <18 kg donors were used en bloc (n = 39, 72.2% vs n = 15, 27.8%). Donor weight (kg) was similar between the 2 groups (12.3 ± 3.2 vs 14.1 ± 2.5, P = .05). Recipient weight was lower in the solitary kidney group (P = .01). Both groups had a similar donor-to-recipient body weight ratio (0.24 ± 0.3 vs 0.18 ± 0.3, P = .51). The solitary kidney group had a lower estimated glomerular filtration rate at 1 (56.9 ± 24.3 vs 81.8 ± 24.8, P = .01) and 2 years (72 ± 18.6 vs 93.7 ± 21.6, P = .03). By 2 years, both groups had an average estimated glomerular filtration rate >60 mL/min. Kidney allograft growth occurred in both groups, with the largest increase occurring the first month posttransplant (11.9%, 18.6%, P < .0001).
For pediatric donors weighing <18 kg, improvements in renal function continue beyond the first posttransplant year. Risk for hyperfiltration injury appears low and renal mass-recipient mass matching is useful in guiding decision-making for solitary vs en bloc utilization.
来自非常年幼的儿科供体的肾脏仍未得到充分利用。为了减少浪费，器官获取与移植网络（OPTN）的政策最近进行了更新，允许回收体重<18 公斤的供体的肾脏整块使用。
我们回顾了我们中心在接受<18 公斤儿科供体肾脏的成人受体中进行肾移植的经验，以评估单独使用与整块使用特定于孤立肾脏与整块使用的肾功能结果。
大多数<18 公斤的供体是整块使用（n=39，72.2%比 n=15，27.8%）。两组供体体重（公斤）相似（12.3±3.2 比 14.1±2.5，P=0.05）。孤立肾组的受体体重较低（P=0.01）。两组的供体与受体体重比相似（0.24±0.3 比 0.18±0.3，P=0.51）。孤立肾组在 1 年（56.9±24.3 比 81.8±24.8，P=0.01）和 2 年（72±18.6 比 93.7±21.6，P=0.03）时的估计肾小球滤过率较低。到第 2 年，两组的平均估计肾小球滤过率均>60 mL/min。两组的肾移植均发生生长，第一个月移植后增加最大（11.9%，18.6%，P<.0001）。
对于体重<18 公斤的儿科供体，肾功能的改善持续到移植后第 1 年以后。发生超滤损伤的风险似乎较低，肾脏质量与受体质量匹配有助于指导孤立肾脏与整块使用的决策。
