| Abstrakt: |
From January 1986 through December 1998, 175 adults received single kidneys from donors less than 60 months of age. Recipient age ranged from 16 to 66 years (mean 41.2 years), weight from 75 to 186 lb (mean 138 lb), and no exclusion was made for previous transplants, diabetes, or factors other than weight. Donor age ranged from 9 to 56 months (mean, 25.3 months), weight from 9 to 60 lb (mean, 28 lb), and cold ischemia time from 12 to 52 hours (mean, 32 hours). Donor kidneys were received en bloc and separated before transplantation. Surgical technique featured interrupted venous anastamosis, an aortic patch for the renal artery anastamosis, and urinary reconstruction with uretero-ureterostomy. Immunosuppression evolved through three phases, stressing avoidance of early rejection and prompt, vigorous treatment of rejection episodes. Current immunosuppression includes antibody induction, cyclosporine or tacrolimus, mycophenolate and steroids. Allograft survival rates have improved during the series: 1-, 3-, and 5-year actuarial allograft survival from 1986 to 1990 (n = 25 patients) was 60%, 44%, and 44%; from 1990 to 1995 (n = 92 patients), 75%, 60%, and 54%; and from 1996 to the present, 1-year allograft survival has been 90%, with no graft losses to rejection. This current allograft survival rate is equivalent to that of patients receiving an organ from an adult donor age 18 to 45 years in our center. Surgical complications occurred in 10.8% of cases, the most serious being allograft thrombosis in 3.4%, most in kidneys from donors less than 24 months of age. Long-term allograft function and loss have not been different from recipients of adult kidneys. Single kidneys from donors less than 60 months of age can be used successfully in adult recipients with satisfactory long-term function and no significant increase in risk with current immunosuppression. A concerted effort should be made to recover and transplant younger kidneys as single units to increase organ availability and optimally use donor resources. |
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