Is donor age 6 years or less related to increased risk of surgical complications in pediatric kidney transplantation

Summary Introduction Despite the widespread organ shortage dilemma, there is hesitancy regarding utilization of young donors (aged ≤6 years) because previous reports have suggested that this is associated with an increased risk of surgical complications and graft loss. Objective The aim of this study was to determine if donor age ≤6 years is related to increased risk of surgical complications or allograft loss in pediatric kidney transplantation (KT). Study design A retrospective study of pediatric kidney transplants (KT) undertaken between January 2000 and July 2015. The incidence of surgical and urological complications, and allograft loss were analyzed and compared between donors aged ≤6 years (Group 1) and donors aged >6 years (Group 2). Results A total of 171 pediatric KTs were performed at the current center during the study period. Twenty-eight patients were excluded; as a result, the study comprised 143 patients: 60 (Group 1) and 83 (Group 2). Mean recipient weight was 17 kg (SD 9.7; range 3.2–47) in Group 1 and 38.2 kg (SD 15.3; range 7.8–73) in Group 2. Despite a significantly higher proportion of risk factors in Group 1, no significant between-group differences were observed in terms of: surgical complications (OR 0.4; range 0.1–1.2), early urological complications (OR 2.2; range 0.4–11), late urological complications (OR 0.3; range 0.8–1.4), lymphoceles (OR 6.2; range 0.7–51.7) and allograft loss (OR 1.5; range 0.7–3.1, summary Table). Graft survival at 1 and 5 years was: 81% and 70% (Group 1) and 92% and 79% (Group 2), respectively ( P  = 0.093). Mean follow-up was 90.13 ± 49.7 months. Discussion The main finding of this retrospective study was that pediatric donor kidneys from donors aged ≤6 years could safely be used in pediatric recipients without an increased risk of surgical and urological complications or graft loss. Nevertheless, KT with small donor kidneys is challenging and should be performed at experienced pediatric centers. Conclusion In line with these results, the outcomes of KT using donors aged ≤6 years were encouraging and similar to those obtained with older donors. Thus, this study supported using kidney grafts from young donors, given the organ shortage and potential high mortality risk while awaiting KT. Summary Table Surgical and urological complications, and allograft loss. Group 1: donor age ≤6 years ( n  = 60) n (%) Group 2: donor age >6 years ( n  = 83) n (%) P -value OR (95% CI) Surgical complications 12 (20) 10 (12.1) 0.193* 2.0 (0.8–5.2) Early urological complications 2 (3.3) 6 (7.2) 0.468° 0.4 (0.08–2.2) Late urological complications 6 (10) 3 (3.6) 0.116° 0.3 (0.8–1.4) Lymphocele 1 (1.7) 8 (9.6) 0.079° 6.2 (0.7–51.7) Reintervention 13 (22) 14 (17.1) 0.778* 0.7 (0.3–1.6) Graft loss due to surgical complications 5 (8.3) 2 (2.4) 0.240° 3.1 (0.5–18.2) Graft survival  1 year 81% 92% 0.093 +  5 years 70% 79%