Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, China.
Transplantation. 2023 Jul 1;107(7):1564-1572. doi: 10.1097/TP.0000000000004534. Epub 2023 Jun 20.
Kidneys from very small pediatric donors (VSPDs, aged <2 y) are underutilized. Concerns regarding potentially inferior outcomes hinder the use in pediatric recipients.
All pediatric kidney-only transplants from <18-year-old donors between January 2012 and May 2021 in our center were included in this study. Outcomes were compared between VSPD and normal pediatric donor (NPD, aged 2-18 y) groups, and 3-y death-censored graft survival was assessed by the multivariable Cox proportional hazard model.
Of all 252 enrolled patients, 149 (59.1%) received kidneys from NPDs and 103 (40.9%) from VSPDs. The 3-y graft survival rates of the NPD and VSPD groups were 91.2% and 88.6%, respectively ( P = 0.385). The adjusted hazard ratio of 3-y graft loss was 1.2 (95% confidence interval, 0.6-2.5; P = 0.659) for the VSPD group compared with the NPD group. There was no significant difference in estimated glomerular filtration rate at 3 y posttransplant observed between NPD and VSPD groups (86.9 ± 26.8 versus 87 ± 27.9 mL/min/1.73 m 2 ; P = 0.991). Patients (n = 12, 4.8%) who received kidneys from donors <5 kg contributed 5 (5/39, 12.8%) with delayed graft function and the sole primary nonfunction in our cohort.
Although attention to preventing complications is necessary, especially for kidneys from donors <5 kg, kidneys from VSPDs did not appear to impart added risk for 3-y graft loss and renal function.
来自非常小的儿科供体（VSPD，年龄 <2 岁）的肾脏未得到充分利用。对潜在较差结果的担忧阻碍了在儿科受者中的使用。
本研究纳入了 2012 年 1 月至 2021 年 5 月期间我们中心所有来自 <18 岁供体的单纯儿科肾脏移植患者。比较了 VSPD 与正常儿科供体（NPD，年龄 2-18 岁）组的结果，并通过多变量 Cox 比例风险模型评估了 3 年死亡风险的移植物存活率。
在所有 252 名入组患者中，149 名（59.1%）接受了 NPD 供体的肾脏，103 名（40.9%）接受了 VSPD 供体的肾脏。NPD 和 VSPD 组的 3 年移植物存活率分别为 91.2%和 88.6%（P=0.385）。与 NPD 组相比，VSPD 组 3 年移植物丢失的调整后风险比为 1.2（95%置信区间，0.6-2.5；P=0.659）。NPD 和 VSPD 组在移植后 3 年的估算肾小球滤过率无显著差异（86.9±26.8 与 87±27.9 mL/min/1.73 m 2 ；P=0.991）。在我们的队列中，来自体重 <5 kg 供体的 12 名（4.8%）患者有 5 名（5/39，12.8%）发生了延迟移植物功能和唯一的原发性无功能。
尽管需要注意预防并发症，尤其是对于来自体重 <5 kg 供体的肾脏，但 VSPD 的肾脏似乎不会增加 3 年移植物丢失和肾功能的风险。
