TRANSPLANTATION OF THE ADULT KIDNEY INTO THE VERY SMALL CHILD - LONG-TERM OUTCOME

Adult kidneys were transplanted into 12 children weighing between 5400-8800 g. Ten received parental and 2 received cadaver grafts. Of the 12 children, 10 are alive 18 mo. 9 yr posttransplant; 8 have their original grafts and 2 required retransplantation, their original grafts were lost at 4 and 9 yr because of chronic rejection. All but 2 surviving children had normal or accelerated growth rates despite growth retardation prior to transplant. All children evidenced moderate to severe delay in psychomotor development prior to transplant. Of the 10 survivors, 7 now have normal psychomotor function. Two are behind in school, and one, with a degenerative CNS disease prior to transplant, remains profoundly retarded. Because of donor availability, capacity for good donor-recipient matching and minimization of time on dialysis, transplantation of adult kidneys into pediatric patients may be preferable to awaiting the relatively uncommon pediatric cadaver donor. Apparently, the procedure is warranted.