>Year 2002, Issue 2
Hernández DM, Holm CA, Jiménez DA, Camarena AA, Soberanes HA, Lagunas MJ, García BJA, Reyes RP
Renal transplantation from pediatric cadaveric donors
Cir Gen 2002; 24 (2)
PDF: 4. Kb.
Objective: To demonstrate the degree of functionality of pediatric grafts from cadaveric donors of different ages.
Setting: Third level health care hospital.
Design: Retrospective case studies.
Material and methods: From January 1st, 1995 to August 31st, 1997 (32 months) 38 multiple organ procurements were effectively accomplished. Thirty renal grafts were obtained from pediatric donors. Perfusion with MPS solution and simple hypothermia preservation was used for all procedures made in donors of less than 15 years of age. Donors were divided in two subgroups: Group A (1-4 years of age) and B (5 to 14 years of age). The receptors received a triple immunosuppressor scheme, cyclosporine-A (CyA), azathioprine (Aza) and prednisone (Pdn). Steroid-resistant cases were treated with monoclonal antibodies (OKT-3) according to the conventional scheme.
Results: From the 38 procurements, 10 corresponded to children under 15 years of age. From the 20 available grafts, 18 were transplanted, since one renal block presented generalized hemorrhagic spots. Subgroup A comprised 14 grafts, of which four presented dysfunction and two more had macroscopic alterations (43%). Subgroup B, with six grafts from three donors, presented a 100% functionality at 1 year and only one presented two acute rejection episodes that responded favorably to treatment. Three nephrectomies of the graft were performed in subgroup A, caused by venous thrombosis, severe cardiac failure in one marginal patient with functioning graft, and rupture of the graft due to non-vascular cause in another.
Conclusion: Grafts from pediatric donors under six years of age presented 43% of primary dysfunction. Donors over 5 years of age presented a satisfactory evolution and favorable prognosis.
||Pediatric cadaveric donor, multiorganic procurement, pulsatile perfusion, simple hypothermia, renal graft.
Gjertson DW, Cecka JM. Determinants of long-term survival of pediatric kidney grafts reported to the United Network for Organ Sharing kidney transplant registry. Pediatr Transplant 2001; 5: 5-15.
Pugliese MR, Ridolfi L, Nanni Costa A, Taddei S, Venturoli N, Petrini F. A comparison of pediatric and adult kidney donors for adult recipients. Transpl Int 1999; 12: 122-6.
Sarwal MM, Cecka JM, Millan MT, Salvatierra O Jr. Adult-size kidneys without acute tubular necrosis provide exceedingly superior long-term graft outcomes for infants and small children: a single center and UNOS analysis. United Network for Organ Sharing. Transplantation 2000; 27; 70: 1728-36.
Bradley BA. Does the risk of acute rejection really decrease with increasing recipient age? Transpl Int 2000; 13 Suppl 1: S42-4.
Crocker JF, Wade AW, McDonald AT, McLellan DH, Lawen JG, Bitter-Suermann H et al. Kidney graft loss in children: implications for program development. CMAJ 1998; 159: 229-35.
Soberanes A, Baltasar S, Cervantes L, Tovar B, Villalobos E, Calderon M et al. Legal basis for cadaver donation in Mexico: a simple diagram that facilitates the legal procedure, initial experience. Transplant Proc 1997; 29: 3228-30.
Soberanes A, Vicente A, Núñez S, Lagunas J, Tovar B, Cervantes L et al. New donation program at a Mexican Social Security Institution: a Mexican model of cadaver donation and organ sharing-initial experience. Transplant Proc 1997; 29: 3307-8.
Hernández-Domínguez JM, Holm CA, Jiménez DA, Camarena APA, Sánchez RJ, Pérez ML. Desarrollo histórico del Servicio de Trasplantes. Hospital General Centro Médico Nacional, “La Raza”, IMSS. Cir Gen. 2002:24:107-11.
Ishitani M, Isaacs R, Norwood V, Nock S, Lobo P. Predictors of graft survival in pediatric living-related kidney transplant recipients. Transplantation 2000; 70: 288-92.
Yagisawa T, Kam I, Chan L, Springer JW, Dunn S. Limitations of pediatric donor kidneys for transplantation. Clin Transplant 1998; 12: 557-62.
Cicciarelli J, Iwaki Y, Méndez R. The influence of donor age on kidney graft survival in the 1990s. Clin Transpl 1999: 335-40.
Suri D, Meyer TW. Influence of donor factors on early function of graft kidneys. J Am Soc Nephrol 1999; 10: 1317-23.
Tejani AH, Sullivan EK, Alexander SR, Fine RN, Harmon WE, Kohaut EC. Predictive factors for delayed graft function (DGF) and its impact on renal graft survival in children: a report of the North American Pediatric Renal Transplant Cooperative Study (NAPRTCS). Pediatr Transplant 1999; 3: 293-300.
>Year 2002, Issue 2