Ten‐year experience with infant kidneys transplantated en bloc

We analyzed the long‐term outcome and function of 78 pairs of infant kidneys transplanted en bloc into adult recipients from February 1987 to February 1997. Donors were 31.2 months old (3.5–60 months), weighed 10.9 kg (5.6–20 kg), and had creatinine levels of 0.3 mg/dl (0.2‐0.8 mg/dl). The kidneys had 2.6 (0–6) HLA‐A, B, DR, mismatched antigens. Recipients were 36.3 years old (18–78 years), had 3.3% panel‐reactive antibodies (0–71 %), and weighed 71.5 kg (46–134 kg). Renal revascularization was accomplished by joining the donor aorta and vena cava to the recipient iliac artery and vein, respectively. Cold ischemia time was 23.4 h (16–53 h). Immunosuppression consisted of cyclosporine, azathioprine, steroids, and recently, mycophenolate mofetil. Rejection episodes were treated with steroids, and anti‐CD 3 antibodies was used in non‐responders. Five en‐bloc kidneys thrombosed. Two ureters developed a fistula and were repaired successfully. Five patients underwent dialysis. Death occurred in two patients with infection, six with heart attack and stroke, and one with cancer with excellent graft function. Renal artery stenosis was dilated in seven patients. Six grafts were lost to rejection (one from non‐compliance at 20 months). The original disease recurred in three patients with massive proteinuria, despite excellent function. Graft survival at 42 months (1–117 months) was 79%, with serum creatinine levels at 1, 3, and 9 years of 1.2, 1.0, and 0.8 mg/dl, respectively. Creatinine clearance averaged 88 ml/min (34–188 ml/min) and 24‐h proteinuria was 146 mg (normal 10–150 mg). In conclusion: (1) en‐bloc infant kidneys can be transplanted successfully with excellent long‐term function into adults; (2) hyperfiltration injury was not observed; and (3) infant kidneys should be used more frequently.