En-bloc kidney transplants from very small pediatric donors: a propensity score matched analysis
BackgroundKidneys from brain-death small pediatric donors ≤2 years are still classified as marginal organs. Herein, we analyse the outcomes following en-bloc kidney transplantation (EBKT) from pediatric donors ≤2 years into adult recipients compared to standard criteria donor kidney transplant recip...
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Frontiers Media S.A.
2025-04-01
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| Series: | Frontiers in Pediatrics |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fped.2025.1570489/full |
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| author | Silvia Oberparleiter Felix J. Krendl Thomas Resch Rupert Oberhuber Hannah Esser Florian Ponholzer Annemarie Weissenbacher Robert Breitkopf Hannes Neuwirt Stefan Schneeberger Manuel Maglione Benno Cardini |
| author_facet | Silvia Oberparleiter Felix J. Krendl Thomas Resch Rupert Oberhuber Hannah Esser Florian Ponholzer Annemarie Weissenbacher Robert Breitkopf Hannes Neuwirt Stefan Schneeberger Manuel Maglione Benno Cardini |
| author_sort | Silvia Oberparleiter |
| collection | DOAJ |
| description | BackgroundKidneys from brain-death small pediatric donors ≤2 years are still classified as marginal organs. Herein, we analyse the outcomes following en-bloc kidney transplantation (EBKT) from pediatric donors ≤2 years into adult recipients compared to standard criteria donor kidney transplant recipients (SKTs).MethodsA retrospective single center analysis of a prospectively collected and auditable database identified six EBKTs and 75 SKTs between January 2015 and June 2017. Propensity score matching minimized selection bias.ResultsAfter a median follow-up of 74 months, five-year patient and graft survival were 100%, each in the EBKTs group. Following SKTs, the five-year patient survival rate was 94.7%, likewise death-censored graft survival reached 94.7%. Two EBKT cases experienced unilateral arterial graft thrombosis requiring unilateral nephrectomy, with full recovery and good kidney function. At hospital discharge, recipients of EBKTs showed decreased eGFR compared to SKTs, however, from 3 months onward this reversed and following a median follow-up of 74 months the median eGFR was twice as high after EBKT compared to SKT (107 ml/min/1.73m2 vs. 52 ml/min/1.73m2, p < 0.001). These favourable results persist in the PSM analysis.ConclusionEBKTs from very small pediatric donors show excellent long-term kidney function. The higher incidence of postoperative complications does not translate into poorer mid-term patient and graft survival. |
| format | Article |
| id | doaj-art-5bf43a64db704f0ca58525b1197d4e8f |
| institution | DOAJ |
| issn | 2296-2360 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Pediatrics |
| spelling | doaj-art-5bf43a64db704f0ca58525b1197d4e8f2025-08-20T03:14:13ZengFrontiers Media S.A.Frontiers in Pediatrics2296-23602025-04-011310.3389/fped.2025.15704891570489En-bloc kidney transplants from very small pediatric donors: a propensity score matched analysisSilvia Oberparleiter0Felix J. Krendl1Thomas Resch2Rupert Oberhuber3Hannah Esser4Florian Ponholzer5Annemarie Weissenbacher6Robert Breitkopf7Hannes Neuwirt8Stefan Schneeberger9Manuel Maglione10Benno Cardini11Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, Innsbruck, AustriaDepartment of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, Innsbruck, AustriaDepartment of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, Innsbruck, AustriaDepartment of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, Innsbruck, AustriaDepartment of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, Innsbruck, AustriaDepartment of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, Innsbruck, AustriaDepartment of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, Innsbruck, AustriaDepartment of Anesthesiology and Intensive Care, Medical University of Innsbruck, Innsbruck, AustriaDepartment of Internal Medicine IV, Nephrology and Hypertension, Medical University of Innsbruck, Innsbruck, AustriaDepartment of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, Innsbruck, AustriaDepartment of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, Innsbruck, AustriaDepartment of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, Innsbruck, AustriaBackgroundKidneys from brain-death small pediatric donors ≤2 years are still classified as marginal organs. Herein, we analyse the outcomes following en-bloc kidney transplantation (EBKT) from pediatric donors ≤2 years into adult recipients compared to standard criteria donor kidney transplant recipients (SKTs).MethodsA retrospective single center analysis of a prospectively collected and auditable database identified six EBKTs and 75 SKTs between January 2015 and June 2017. Propensity score matching minimized selection bias.ResultsAfter a median follow-up of 74 months, five-year patient and graft survival were 100%, each in the EBKTs group. Following SKTs, the five-year patient survival rate was 94.7%, likewise death-censored graft survival reached 94.7%. Two EBKT cases experienced unilateral arterial graft thrombosis requiring unilateral nephrectomy, with full recovery and good kidney function. At hospital discharge, recipients of EBKTs showed decreased eGFR compared to SKTs, however, from 3 months onward this reversed and following a median follow-up of 74 months the median eGFR was twice as high after EBKT compared to SKT (107 ml/min/1.73m2 vs. 52 ml/min/1.73m2, p < 0.001). These favourable results persist in the PSM analysis.ConclusionEBKTs from very small pediatric donors show excellent long-term kidney function. The higher incidence of postoperative complications does not translate into poorer mid-term patient and graft survival.https://www.frontiersin.org/articles/10.3389/fped.2025.1570489/fullkidney transplantationlong-term outcomemarginal organspostoperative complicationspediatric donors |
| spellingShingle | Silvia Oberparleiter Felix J. Krendl Thomas Resch Rupert Oberhuber Hannah Esser Florian Ponholzer Annemarie Weissenbacher Robert Breitkopf Hannes Neuwirt Stefan Schneeberger Manuel Maglione Benno Cardini En-bloc kidney transplants from very small pediatric donors: a propensity score matched analysis Frontiers in Pediatrics kidney transplantation long-term outcome marginal organs postoperative complications pediatric donors |
| title | En-bloc kidney transplants from very small pediatric donors: a propensity score matched analysis |
| title_full | En-bloc kidney transplants from very small pediatric donors: a propensity score matched analysis |
| title_fullStr | En-bloc kidney transplants from very small pediatric donors: a propensity score matched analysis |
| title_full_unstemmed | En-bloc kidney transplants from very small pediatric donors: a propensity score matched analysis |
| title_short | En-bloc kidney transplants from very small pediatric donors: a propensity score matched analysis |
| title_sort | en bloc kidney transplants from very small pediatric donors a propensity score matched analysis |
| topic | kidney transplantation long-term outcome marginal organs postoperative complications pediatric donors |
| url | https://www.frontiersin.org/articles/10.3389/fped.2025.1570489/full |
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