Excellent clinical long-tong outcomes of en-bloc kidney transplantation from small donors (age≤6 months) despite the higher risk of thrombosis

Background: En-bloc kidney transplantation may result in single-kidney survival due to thrombosis. As these patients are relatively rare, there are few reports on the complications and long-term outcomes of single-kidney survival patients.
Method: We included the cohort data of 41 cases of recipients (with donor age ≤ 6 months) undergoing en-bloc kidney transplantation from July 2013 to November 2018. After excluding 4 cases with early dual kidney embolism, the patients were divided into the single kidney survival group (SKS, n=14) and the dual kidney survival group (DKS, n=23).
Result: Donor’s and recipient’s median weights were 4.0kg and 37kg. At 1 month after transplantation, the estimate glomerular filtration rate(eGFR) of recipients in the DKS group was significantly higher than that of recipients in the SKS group (68.6 ± 26.1mL/min/1.73m² vs. 45.3 ± 26.2 mL/min/1.73m², p = 0.019), but there was no difference after 6 months of transplantation (110.5 ± 46.4 mL/min/1.73m² vs. 93.5± 41.0 mL/min/1.73m², p = 0.312). At the last follow-up, the eGFR of recipients in the DKS group was better than that of recipients in the SKS group (105.4 ± 23.9 mL/min/1.73m² vs. 81.0 ± 2.59 mL/min/1.73m², p = 0.036). The death-censored graft survival rate for the SKS group at 1, 5, and 8 years were 100%, 92%, and 58%, respectively, while for the DKS group, it was 95%, 95%, and 58%, respectively, there was no difference between the two groups. (p = 0.587).
Conclusion: For kidneys donated by infants under 6 months of age, even if only one kidney survives after transplantation, the long-term outcome can be very similar to that of DKS. Legends： Figure 1: Graft function after kidney transplantation. (A) One month after transplantation, the creatinine level in the SKS group was higher than that in the DKS group. However, after six months, there was no significant difference in the creatinine levels between the two groups. (B) Five years after transplantation, the eGFR of the DKS group was superior to that of the SKS group. Figure 2: Graft survival and recipient survival after kidney transplantation.