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Vol. 46. Issue 2.
Pages 85-91 (March 2022)
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Vol. 46. Issue 2.
Pages 85-91 (March 2022)
Original article
A 20-year experience in cadaveric pediatric en bloc kidney transplantation in adult recipients
20 años de experiencia en trasplante renal en bloque de donantes pediátricos en receptores adultos
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J.A. López-González
Corresponding author
joseagustin.lgonzalez@gmail.com

Corresponding author.
, M. Beamud-Cortés, L. Bermell-Marco, M.A. Pérez-Martínez, M.D. Cuenca-Ramírez, L.M. Moratalla-Charcos, J. Planelles-Gómez, M. Sánchez-Sanchís, J.F. Vidal-Moreno
Servicio de Urología, Hospital Universitari Doctor Peset, Valencia, Spain
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Tables (4)
Table 1. Demographic characteristics.
Table 2. Serum creatinine values of patients during follow-up expressed as mean and standard deviation.
Table 3. Creatinine clearance and 24 h urine proteinuria of patients during follow-up expressed as mean and standard deviation.
Table 4. Graft loss causes correlated with donor and recipient data.
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Abstract
Background and objectives

En bloc kidney transplantation (EBKT) from pediatric donors into adult recipients increases the donor pool. However, this surgical procedure is not widely performed in many transplant centers. To evaluate the long-term outcomes of EBKT from pediatric donors into adult recipients in a single center.

Material and methods

Retrospective analysis of 42 patients who received pediatric cadaveric EBKT in our center since 1999. Median follow-up period was 73 months (5−233) in which renal function tests were taken and complications registered.

Results

We have performed 42 EBKT from pediatric donors into adult recipients in our center. The recipients’ age was 44.1 ± 11.8 years. Pediatric donors were 22.4 ± 14.7 months old and weighted 11.3 ± 3.6 kg. Cold ischemia time was 15.7 ± 4.5 h. During a median follow-up of 73 months, 35 patients (83.3%) had graft survival with excellent function (first-year serum creatinine levels of 0.99 ± 0.25 mg/dl). There were seven graft losses (16.7%) in the immediate postoperative period (four cases of vascular thrombosis, one anastomosis dehiscence and two cortical necrosis).

Conclusions

The pediatric en bloc renal graft transplantation into adults is a safe technique with excellent medium- to long-term functional performance. The vast majority of significant complications leading to graft loss were reported in the immediate postoperative period. A good selection of donors and recipients as well as an adequate surgical technique are essential to minimize the occurrence of adverse events.

Keywords:
En bloc kidney transplant
Kidney transplantation
Pediatric donor
Adult recipient
Resumen
Introducción y objetivos

el trasplante renal en bloque de donantes pediátricos en receptores adultos permite aumentar el pool de donantes pero son pocos los centros que lo realizan. Mostramos los resultados de la técnica en nuestro centro tras su introducción en el año 1999.

Material y métodos

análisis retrospectivo de los 42 procedimientos realizados en nuestro centro con una mediana de seguimiento de 73 meses [5–233] en los que se monitorizó la función renal de los pacientes y se registraron las complicaciones sucedidas.

Resultados

se han realizado 42 trasplantes renales en bloque en adultos de donantes pediátricos en nuestro centro hasta el momento. La media de edad de los receptores fue de 44.1 ± 11.8 años y la de los donantes de 22.4 ± 14.7 meses con un peso medio de 11.3 ± 3.6 kg. El tiempo medio de isquemia fría fue de 15.7 ± 4.5 horas. Al finalizar el seguimiento, 35 injertos eran funcionantes (83.3%) y mantenían una excelente función. Hubo siete pérdidas de injerto (16.7%) en el postoperatorio inmediato (cuatro trombosis vasculares, una dehiscencia de anastomosis y dos necrosis corticales) y un éxitus durante el seguimiento por una causa no relacionada.

Conclusiones

el uso de injertos renales en bloque de origen pediátrico en adultos es un procedimiento seguro y con un excelente rendimiento funcional a medio y largo plazo. El postoperatorio inmediato es el periodo donde se establecen la mayoría de las complicaciones importantes que pueden derivar en la pérdida del injerto. La adecuada selección de donantes y receptores, así como una correcta técnica quirúrgica son imprescindibles para minimizar la aparición de eventos adversos.

Palabras clave:
Trasplante renal en bloque
Trasplante renal
Donante pediátrico
Receptor adulto

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