Abstract: SA-PO956

Long Term Function of Pediatric En Bloc Kidneys: A Single Center Study

Session Information

Category: Nephrology Education

  • 1302 Fellows and Residents Case Reports

Authors

  • Habbach, Amr, Westpenn Allegheny Health Network, Pittsburgh, Pennsylvania, United States
  • Sureshkumar, Kalathil K., Westpenn Allegheny Health Network, Pittsburgh, Pennsylvania, United States
Background

Pediatric en bloc kidneys are considered "marginal" and many transplant centers are reluctant to use them. However, these kidneys double the number of nephrons and previous studies have shown that when exposed to adult hemodynamics these kdineys grow to adult size within first year. We aimed to compare extended long term function of pediatric en bloc kidneys to living donor kidneys performed at our institution.

Methods

This is a single center restrospective study of pediatirc en bloc and living donor kidney transplants performed at our center between January 1990 and December 2001 who had functiong graft beyond 5 years . Graft survival, yearly serum creatinine and estimated GFR using modified MDRD equation were calculated and compared between en bloc and living donor kidney recipients.

Results

There were 72 patients in the en bloc and 75 in the living donor group who were transplanted during the study period. Maximum available follow up for serum creatinine value was 17 years following transplantation. Kaplan-Meier survival analysis showed no difference in graft survival between the groups over 27 years of follow up (long rank p 0.78). However on regression analysis, allograft function was found to be superior for en bloc vs. living donor kidney recipients longitudinally as evidenced by higher estimated GFR (33.0 + 7.8 ml/min, p<0.0001) as shown in figure.

Conclusion

Our single center study showed simlar graft survival but superior long term graft function as measured by estimated GFR among pediatric en bloc kidneys compared to living donor kidneys. This could be related to increased "nephron dose" among en bloc kidneys which could likely make them less susceptible to hyperfiltration injury in the long term. Our study encourages more widespread use of en bloc kidneys which can alleviate organ shortage while providing excellent long-term function. Strengths of our study include relatively large number of study patients and extended available follow up.