Organ recovery from pediatric donor after cardiac death and kidney transplantation

Objective To investigate the feasibility of pediatric organ donation after cardiac death (DCD) and summarize the clinical outcomes and the experience of transplantation of single pediatric kidney.Method A retrospective analysis of the data was done on the procedure of 5 cases of pediatric organ donation and transplant outcomes at our center.The donors were at age 4 to 9 with one case of cerebral hypoxia after cardiopulmonary resuscitation,two cases of severe traumatic brain injury and two cases of malignant brain tumors,respectively.Four cases were classed as category Ⅲ of China DCD Classification and one as category Ⅱ.Ten kidneys were recovered after in situ perfusion using liver-kidney en bloc resection.Result Zero biopsy was performed in four kidneys from four donors.Pathologically,one case had focal global and segmental podocyte injury with significant tubular cloudy swelling and interstitial edema,and three cases had mild pathological changes.Ten kidneys were all transplanted to 3 pediatric recipients and 7 adult ones.The recipients' weight was 35 to 69 kg.Delayed graft function occurred in two cases.Compensatory hypertrophy occurred in all kidneys with a length of 10.46 ± 0.19 cm at 6 months post-transplant from 7.74 ± 0.68 at baseline.Renal arterial stenosis was observed in one patient,who was cured with interventional balloon dilatation and stent implantation.Eight patients were followed up for ＞ 6 months with normal serum creatinine levels except for one of 133 μmol/L by the last visit.The eGFR levels were 1.87,1.78 and 1.06 ml/s in 3 children,respectively,and 0.82-1.34 ml/s in 7 adults.All recipients were not serious lung and urinary tract infection.Conclusion Pediatric DCD is a critical potential complement for organ pool and diagnostic criteria for cerebral lesions should be strictly adhered to.Single pediatric kidney transplantation with a length ＞ 7 cm is acceptable.Good surgical skills and comprehensive postoperative care are essential for successful pediatric kidney donation and transplantation. Key words: Children; Organ donation; Kidney transplantation; Death; Renal function