Huang Mingchuan, Wu Shenghui, Gao Pengfei, Zhou Li, Fu Qian, Wu Chenglin, Zhang Huanxi, Zheng Yitao, Su Xiaojun, Wu Wenrui, Tan Jinghong, Zhang Qiang, Xia Pei, Xu Zhe, Liu Longshan, Li Jun, Wang Changxi
Department of Pediatric Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
Organ Transplantation Center, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
Ren Fail. 2025 Dec;47(1):2454968. doi: 10.1080/0886022X.2025.2454968. Epub 2025 Jan 22.
Dual kidney transplantation (DKT) from small pediatric donors, either en-bloc or split dual kidney transplantation, contributes to mitigating organ scarcity. This study investigates the prognosis of DKT from pediatric deceased donors, and influencing factors.
A retrospective study included recipients who underwent DKT from pediatric donors between 2012 and 2022. Recipients were categorized into low mismatch (BWLM, = 30) and high mismatch (BWHM, = 10) groups based on donor-recipient weight ratio of 1:10. Outcome encompassed recipient and graft survival, renal function, and adverse events.
Forty recipients were included. The average follow-up period was 54.6 months. The 1, 3, and 5-year patient survival were 97.4%, with no significant differences between en-bloc and split dual kidney transplantation or between BWLM and BWHM groups. The graft survival at 1, 3, and 5 years were 89.9%, the graft survival of BWHM group was lower than BWLM group (70% vs 96.7%, = 0.039). The average eGFR at 1, 3, and 5 years postoperatively were (78.93 ± 25.23), (83.82 ± 32.4), and (85.92 ± 37.08) mL/min/1.73 m, respectively. The BWHM group also experienced higher rates of graft-related surgical complications ( = 0.006) and urinary tract surgical complications ( = 0.042).
DKT from pediatric donors yields favorable outcomes, with similar graft survival and complication rates across surgical subgroups. However, significant donor-recipient weight mismatch, particularly when the ratio is less than 1:10, may contribute to increased surgical complications and poorer graft survival. Efforts to minimize extreme weight mismatch are recommended to optimize outcomes.
来自小儿供体的双肾移植（DKT），无论是整块双肾移植还是劈离式双肾移植，都有助于缓解器官短缺问题。本研究调查了小儿脑死亡供体双肾移植的预后及影响因素。
一项回顾性研究纳入了2012年至2022年间接受小儿供体双肾移植的受者。根据供受者体重比1:10，将受者分为低错配组（BWLM，n = 30）和高错配组（BWHM，n = 10）。观察指标包括受者和移植物存活情况、肾功能及不良事件。
共纳入40例受者。平均随访时间为54.6个月。1年、3年和5年的患者生存率分别为97.4%，整块双肾移植和劈离式双肾移植组之间以及BWLM组和BWHM组之间无显著差异。1年、3年和5年的移植物生存率分别为89.9%，BWHM组的移植物生存率低于BWLM组（70%对96.7%，P = 0.039）。术后1年、3年和5年的平均估算肾小球滤过率（eGFR）分别为（78.93 ± 25.23）、（83.82 ± 32.4）和（85.92 ± 37.08）mL/min/1.73m²。BWHM组还经历了更高的移植物相关手术并发症发生率（P = 0.006）和泌尿系统手术并发症发生率（P = 0.042）。
小儿供体双肾移植预后良好，各手术亚组的移植物存活率和并发症发生率相似。然而，供受者体重显著错配，尤其是当比例小于1:10时，可能会导致手术并发症增加和移植物存活率降低。建议努力尽量减少极端体重错配以优化预后。
