부산대학교 도서관

BACKGROUND:: Kidneys from small deceased pediatric donors with acute kidney injury (AKI) are commonly discarded owing to transplant centers’ concerns regarding inferior short- and long-term posttransplant outcomes. METHODS:: We retrospectively analyzed our center’s en bloc kidney transplants (EBK) performed 11/2007-01/2015 from donors ≤15 kg into adult recipients (≥18 years). We pair-matched grafts from 27 consecutive donors with AKI vs. 27 without AKI for donor weight, DCD status, and preservation time. RESULTS:: For AKI vs. non-AKI donors, median weight was 7.5 vs. 7.1 kg; terminal creatinine was 1.7 (range, 1.1-3.3) vs. 0.3 mg/dL (0.1-0.9). Early graft loss rate from thrombosis or primary nonfunction was 11% for both groups. DGF rate was higher for AKI (52%) vs. non-AKI (15%) grafts (p=0.004). Median eGFR was lower for AKI recipients only at 1 and 3 months (p<0.03). Graft survival (death-censored) at 8 years was 78% for AKI vs. 77% for non-AKI grafts. Late proteinuria rates for AKI vs. non-AKI recipients with >4 years follow-up were not significantly different. CONCLUSIONS:: Small pediatric donor AKI impacted early posttransplant kidney graft function but did not increase risk for early graft loss and decreased long-term function. The presently high nonutilization rates for en bloc kidney grafts from very small pediatric donors with AKI appear therefore unjustified. Based on the outcomes of the present study, we infer that the reluctance to transplant single kidneys from larger pediatric donors with AKI lacks a rational basis as well. Our findings warrant further prospective study and confirmation in larger study cohorts.