SpR and Research Fellow
Guys and Kings college London
Long term outcomes of renal and simultaneous pancreas and kidney transplantation from paediatric donors
Muhammad Arslan Khurram1,2,3, Pankaj Chandak1,2,3, Olivia Shaw4, Ioannis Loukopoulos1, Chris Callaghan1,2,3, Theodoros Kasimatis1, Nikolaos Karydis1, Jelena Stojanovic3, Stephen Marks3, Sheila Boyle3, Helen Jones2, Nick Ware2, Grainne Walsh2, Martin Drage1,2,3, Jonathon Olsburgh1,2,3, Francis Calder1,2,3, Geoff Koffman1,2,3, Nizam Mamode1,2,3, Nicos Kessaris1,2,3.
1Department of Transplantation, Guy's and St. Thomas NHS Foundation Trust, London, United Kingdom; 2Paediatric nephrology and transplantation, Evelina London Childrens Hospital, London, United Kingdom; 3Paediatric nephrology and transplantation, Great Ormond street hospital, London, United Kingdom; 4Clinical Transplantation Laboratory, Guy's & St Thomas' NHS Trust, Viapath, London, United Kingdom
Introduction: Despite concerted efforts to reduce the gap between the patients needing transplantation and available organs, there remains a wide gap. One potential source of precious organs is paediatric donors. There are concerns regarding the small nephron mass, technical issues including risks of thrombosis and long term outcomes. We present our experience of transplantation from paediatric donors from a single centre.
Methods: This is a retrospective, single centre, electronic patient record base analysis of all the recipients undergoing transplantation from paediatric donors from 1997-2018.
Results: There were a total of 237 paediatric donors during this period (99 females, 138 males). The mean age of the donors was 12.5 years (SD 4.2). 192 (81%) organs were from DBD donors while 45 (19%) were DCD donors. The mean recipient age at the time of transplantation was 23.4 years (SD 15.8). 12 (5.1%) organs were transplanted as en-bloc, 45 (19%) were simultaneous pancreas kidney transplants and 180 (75%) were kidney only transplants.
The mean donor age for the en-bloc kidney transplants was 2.3 years (SD 1.56) and the recipient age was 22.3 years (SD 10.6). Patient and renal allograft survival was 100% and 80% respectively for en bloc kidneys (two cases lost to follow up) at mean follow up of 3.9 years (SD 3.5).
36/45 (80%) of the renal allografts from SPK transplants were functioning, 2 patients (4.4%) had died with functioning kidney and 7 (15.6%) had graft failure at last follow up (mean follow up 6.1 years, SD 4.6).
87/180 (48.3 %) of the renal only grafts were functioning, 15 patients (8.3%) had died with a functioning graft and 74 (41.1%) had graft failure at the last follow up (mean follow up 8.8 years, SD 6.5).
There was no difference in the graft survival outcomes of donors ≤ 6 or >6 years of age on Kaplan-Meier analysis (log rank p=0.293).
Conclusions: Despite the concerns, the long-term graft outcomes of kidney transplants from paediatric donors remain comparable to the adult donors. There is no difference in the long-term outcomes between donors <6 years and >6 years of age. Careful selection and utilisation of organs from paediatric donors can lead to acceptable long-term outcomes and is a valid source of increasing the donor pool.
18:30 - 20:00
|Poster Session 1||Long term outcomes of renal and simultaneous pancreas and kidney transplantation from paediatric donors||Exhibit-Poster Area|