Effect of donor body weight on en bloc pediatric kidney transplantation in adults: A systematic review and meta-analysis

Background: The shortage of donor grafts for kidney transplantation remains a critical challenge. En bloc kidney transplantation (EBKT) using small deceased pediatric donors has the potential to expand the donor pool. This review aimed to investigate the outcomes of pediatric-donor EBKT in adults compared with standard single kidney transplantation (SKT). Methods: Relevant databases, including Ovid, Web of Knowledge, Google Scholar, Wiley, and Embase, were searched for eligible studies. Demographic data and transplant outcomes were extracted from the included studies. The primary outcome was graft survival. A random-effects model was used for the meta-analysis. Results: Thirteen studies were included. The median 1-year graft survival rates were 83.8 % and 89.2 % for EBKT and SKT, respectively (risk ratio [RR], 0.97; 95 % confidence interval [CI], 0.93-1.01). The median 5-year graft survival rates were 78.7 % and 72.7 % for EBKT and SKT, respectively (RR, 1.05; 95 % CI, 0.93-1.19). For donors with a body weight > 10 kg (EBKT >10 kg) and <= 10 kg (EBKT <= 10 kg), the median 1-year graft survival rates were 100.0 % and 90.0 %, respectively (RR, 1.08; 95 % CI, 1.05-1.12). Vascular complications were identified as the primary cause of graft loss. Conclusions: Pediatric-donor EBKT in adults is a safe approach with excellent long-term functional outcomes comparable to those of SKT. EBKT represents an effective option to further utilizing pediatric donor kidneys. Outcomes of EBKT vary based on donor body weight. EBKT <= 10 kg was associated with higher short-term graft failure rates despite long-term performance being comparable to EBKT >10 kg.