Objectives: To demonstrate the viability of grafts from pediatric donors transplanted into adult recipients and to analyze new approaches.
Methods: The present series comprised 40 renal transplants in adults utilizing grafts from pediatric donors aged three years or less. A single renal unit was transplanted into each recipient in most of the cases in which grafts from pediatric donors over one year old (n: 26) were used. When the donor was less than one year old and in 3 cases aged over one year (n: 14), both renal units were transplanted en bloc (4 patients) or sequentially (10 patients) into each recipient.
Results: Graft survival rate was 58% at 29 months' mean follow-up (range 5-67) when a single unit was transplanted, 50% at 51 months' mean follow-up (range 49-53) when both renal units were transplanted en bloc and 70% at 22 months' mean follow-up (8-26) when both both renal units were transplanted sequentially. Most of the grafts that were lost were due to problems arising from vascular thrombosis; the incidence of failed grafts from immunological causes was very low. No technical problems were encountered and the urological complications were minimal. Only one case of bladder fistula was observed.
Conclusions: Kidney grafts from pediatric donors of any age are viable for transplantation into adults. In the light of current technological and pharmacological developments, we believe that both renal units should be transplanted into the same recipient-preferably sequentially-if the donor is less than a year old. A single renal unit can be used if the donor is over one year old.