Kidney transplantation from pediatric donors: Size‐match‐based allocation

Use of kidneys from pediatric donors has been associated with worse outcome. We review our 20‐yr experience using pediatric kidneys as single grafts in children and adult recipients. Charts review of 29 recipients, transplanted between 1986 and 2005, who received a graft from a donor ≤6 yr was performed. One recipient received “en bloc” graft and the remaining patients received a single kidney. Nine recipients were adults and 21 were children. Creatinine at discharge and at follow‐up was recorded and actuarial graft and patient survivals were calculated using life table analysis. All 29 recipients are alive at mean follow‐up of 92 months. Five grafts were lost for: primary non‐function (1), recurrent FSGS at 14 month (1) and chronic rejection (3). All five recipients who lost their graft received a graft from donors ≤3 yr. Mean calculated GFR (Schwartz formula) at one and five yr were 84.2 mL/m2/1.73 and 98.3 mL/m2/1.73, respectively. Actuarial graft survival was 93.2%, 89.6%, and 81.9% at one, five and at 10 yr after transplant. The use of a single kidney graft from pediatric donors yields good long‐term results. Kidneys from small pediatric donors should be allocated first to matched‐weight recipients but otherwise can be transplanted in older children or in adults.