Pediatric donors - A risk factor in renal retransplantation

Between January 1971 and February 1988, 1121 cadaver donor kidney transplants were performed at the University of Minnesota. Of these, 873 (77.9%) were from adult (> 15 years of age) donors, 117 (10.4%) from adolescents (> 10, < = 15) and 131 (11.7%) from pediatric (< = 10) donors. Of the last group, 25% of the patients received double and 75% single pediatric cadaver kidney transplants. We compared outcome of pediatric, adolescent and adult donor transplants. There was no difference in patient survival between recipient groups. One- and 5-yr graft survival was 74% and 54% for recipients of adult kidneys, 68% and 53% for recipients of adolescent kidney, and 65% and 46% for recipients of pediatric cadaver kidneys (p = 0.03). Interestingly, the entire difference could be explained by a subgroup - adult or adolescent retransplant recipients of single pediatric kidneys. There was no statistical difference between any groups when primary transplants alone were considered. For pediatric retransplant recipients, there was no difference in outcome if the graft came from a pediatric or adult donor. For the adult or adolescent retransplant recipient most of the difference in graft survival occurred within the first 3 months after transplantation and this difference was maintained throughout the entire follow-up. Analysis of graft loss within the first 3 months revealed that both acute and chronic rejection were more frequent in recipients of pediatric donor kidneys (p = 0.008). We conclude that the single pediatric kidney is associated with significantly worse graft survival in the adult retransplant recipient.