de Santis Feltran Luciana, Genzani Camila Penteado, Hamamoto Fernando, Fonseca Mariana Janiques Barcia Magalhaes, de Camargo Maria Fernanda Carvalho, de Oliveira Nara Léia Gelle, de Freitas Amaral Fabio Cabral, Baptista Jose Carlos, Koch Nogueira Paulo Cesar
Department of Pediatric Kidney Transplantation, Hospital Samaritano de São Paulo, Rua Guapiaçu 121-91, São Paulo, SP, 04024-020, Brazil.
Department of Vascular Surgery, Federal University of São Paulo, UNIFESP, São Paulo, Brazil.
Pediatr Nephrol. 2022 May;37(5):1137-1147. doi: 10.1007/s00467-021-05296-1. Epub 2021 Oct 14.
The use of small pediatric kidneys as single grafts for transplantation is controversial, due to the potential risk for graft thrombosis and insufficient nephron mass.
Aiming to test the benefits of transplanting these kidneys, 375 children who underwent kidney transplantation in a single center were evaluated: 49 (13.1%) received a single graft from a small pediatric donor (≤ 15 kg, SPD group), 244 (65.1%) from a bigger pediatric donor (> 15 kg, BPD group), and 82 (21.9%) from adult living donors (group ALD).
Groups had similar baseline main characteristics. After 5 years of follow-up, children from the SPD group were comparable to children from BPD and ALD in patient survival (94%, 96%, and 98%, respectively, p = 0.423); graft survival (89%, 88%, and 93%, respectively, p = 0.426); the frequency of acute rejection (p = 0.998); the incidence of post-transplant lymphoproliferative disease (p = 0.671); the odds ratio for severely increased proteinuria (p = 0.357); the rates of vascular thrombosis (p = 0.846); and the necessity for post-transplant surgical intervention prior to discharge (p = 0.905). The longitudinal evolution of eGFR was not uniform among groups. The three groups presented a decrease in eGFR, but the slope of the curve was steeper in ALD children. At 5 years, the eGFR of the ALD group was 10 ml/min/1.73m inferior to the others. At that time, the eGFR from the SPD group was statistically similar to the BPD group (p = 0.952).
In a specialized transplant center, the use of a single small pediatric donor kidney for transplantation is as successful as bigger pediatric or adult living donors, after 5 years of follow-up. A higher resolution version of the Graphical abstract is available as Supplementary information.
由于存在移植肾血栓形成的潜在风险以及肾单位数量不足，将小儿小肾脏作为单个移植肾用于移植存在争议。
为了测试移植这些肾脏的益处，对在单一中心接受肾移植的375名儿童进行了评估：49名（13.1%）接受了来自小儿小供体（≤15kg，SPD组）的单个移植肾，244名（65.1%）接受了来自较大小儿供体（>15kg，BPD组）的移植肾，82名（21.9%）接受了来自成人活体供体的移植肾（ALD组）。
各组的基线主要特征相似。随访5年后，SPD组儿童在患者生存率（分别为94%、96%和98%，p = 0.423）、移植肾生存率（分别为89%、88%和93%，p = 0.426）、急性排斥反应发生率（p = 0.998）、移植后淋巴细胞增生性疾病发生率（p = 0.671）、蛋白尿严重增加的比值比（p = 0.357）、血管血栓形成率（p = 0.846）以及出院前移植后手术干预的必要性（p = 0.905）方面与BPD组和ALD组儿童相当。各组间估算肾小球滤过率（eGFR）的纵向变化并不一致。三组的eGFR均有所下降，但ALD组儿童曲线的斜率更陡。5年后，ALD组的eGFR比其他组低10ml/min/1.73m²。此时，SPD组的eGFR与BPD组在统计学上相似（p = 0.952）。
在一个专业移植中心，随访5年后，使用单个小儿小供体肾进行移植与使用较大小儿供体肾或成人活体供体肾一样成功。更高分辨率的图形摘要版本可作为补充信息获取。
