Solitary renal allografts from pediatric cadaver donors less than 2 years of age transplanted into adult recipients

Background. Transplantation of solitary pediatric renal allografts from donors 2 years of age or younger into adult recipients is controversial. Methods. Between 1998 and 2001, 15 solitary renal allografts from pediatric donors 2 years of age or younger were transplanted into adult recipients. Thirty-three en bloc renal allografts transplanted between 1994 and 2001 were used for comparison. En bloc kidneys were considered for separation if they measured greater than or equal to 6 cm in length. Renal function (creatinine clearance [CrCl]) was estimated using the Cockroft-Gault formula. Results. Two-year graft survival for the solitary and en bloc groups were 93% and 77%, respectively (P=0.405). Five grafts were lost because of arterial thrombosis (four en bloc and one solitary). Ureteral complications occurred in three grafts in the en bloc group. One-year postoperative CrCl of the surviving solitary (n=14) and en bloc (n=26) grafts were 51.4 +/- 26.2 mL/min and 55.1 +/- 27.5 mL/min (P > 0.05), respectively. Donor weight and kidney length were greater in the solitary group (14.3 +/- 3.5 kg and 6.3 +/- 0.4 cm, respectively) compared with the en bloc group (10.8 +/- 2.6 kg and 5.9 +/- 0.3 cm, respectively) (P=0.001 and P < 0.001). Conclusions. Separation of en bloc pairs into solitary allografts can be considered when the graft measures greater than or equal to 6 cm in length and donor weight is greater than or equal to 14 kg. The transplantation of solitary pediatric kidneys into adult recipients is successful, and the majority of pediatric en bloc allografts can be separated before transplantation.