En bloc transplantation of infant kidneys: Ten-year experience

Background: Recent data have shown that en bloc infant kidneys transplanted to adult recipients functioned well. Longterm graft survival and function are not available, however. This study analyzes the 10-year experience with transplantation of en bloc infant kidneys from 1987-1997. Study Design: This is a chart review of adult recipients of en bloc infant kidneys with respect to donors' and recipients' age, weight, creatinine, HLA antigen matching, panel reactive antibodies, cold ischemia time, surgical complications, original disease, and longterm graft function and survival. Results: Five en bloc kidneys thrombosed (6.4%). Two ureteral fistulas were repaired successfully. Five patients underwent dialysis (6.4%). Two patients died of infection, six of heart attack and stroke, and one of cancer. All had excellent graft function at patients' death. Renal artery stenosis was dilated in seven patients. Six grafts were lost to rejection (one from noncompliance at 20 months). The original disease recurred in three patients with massive proteinuria despite excellent function. Graft survival at 43 months (range, 6-123 months) was 79%, with serum creatinine levels at 1, 3, 9 and 10 years of 1.2, 1.0, 0.8 and 0.8 mg/dl, respectively. Creatinine clearance averaged 88 mL/min (range, 34-188 mL) and 24-hour proteinuria was 146 mg (normal range, 10-150). Conclusions: In conclusion, en bloc infant kidneys can be transplanted successfully with excellent longterm function, hyperfiltration injury was not observed, and infant kidneys should be used more frequently. (C) 1998 by the American College of Surgeons.