Long-Term Follow-up of Pediatric En Bloc Renal Transplantation K.A. Beasley, F. Balbontin, A. Cook, M. Bloch, V.C. McAlister, J. Lawen, and P.P.W. Luke ABSTRACT We reviewed the outcomes of pediatric en bloc renal transplantation at two Canadian centers in the cyclosporine era. Between 1984 and 2002, 16 patients received pediatric en bloc renal transplants. Mean recipient age and weight were 45  17 years and 72.2  14.4 kg, respectively. En bloc kidneys were procured from donors aged 2.1  0.8 years (range, 0.7 to 4.0), weighing an average of 14.3  2.0 kg (range, 12 to 17). All en bloc kidneys were successfully transplanted without thrombosis. All patients received calcineurin inhibitors and corticosteroids. Only three patients received antibody-based induction therapy. Rejection episodes occurring in seven grafts were all successfully treated. Mean follow-up was 3.7 years (range 0.4 to 15.0). Mean serum creatinine values at 3 months and 1 and 3 years were 138.8  54.5 mol/L, 118.6  38.1 mol/L, and 95.1  24.4 mol/L, respectively. The mean creatinine value of five patients with at least 5 years follow-up was 96.8  12.3 mol/L. Three-year graft and patient survival rates were 94%. Two deaths with functioning grafts occurred secondary to cardiac and infectious etiologies. None of the grafts were lost independent of death. We conclude that en bloc transplantation has excellent short- and long-term results. Improving graft function after 3 years represented by reduced serum creatinine suggests that these kidneys have excellent renal reserve and growth potential. T HE SIGNIFICANT SHORTAGE of cadaveric kidneys available for transplantation continues to prompt ap- proaches to expand donor eligibility. An approach used to ameliorate this shortage is the use of pediatric kidneys for adult recipients. Historically, the use of single pediatric donor kidneys resulted in inferior graft survival rates and was associated with increased rate of technical complica- tions compared with adult donors. 1–4 Explanations for these inferior outcomes include diminished nephron mass, hyperfiltration injury, increased immunogenicity, and di- minished ability of pediatric kidneys to withstand rejec- tion. 5–7 The use of en bloc kidneys from donors aged less than 2 years of age was shown to provide sufficient nephron mass and avoids the hyperfiltration injury associated with the use of solitary pediatric kidneys. 8,9 Despite promising short-term results, there remain concerns regarding high thrombosis rates and a paucity of data with respect to the long-term graft survival rates with the use of en bloc kidneys. We reviewed the long-term results of pediatric en bloc renal transplantation at our two Canadian transplant centers. PATIENTS AND METHODS Retrospective chart review at Dalhousie University and University of Western Ontario identified 16 patients transplanted with pedi- atric en bloc kidneys between June 1984 and July 2002. Kidneys were procured en bloc from heart-beating donors aged between 0.7 and 4.0 years (mean 2.1  0.8 years). The mean weight and terminal serum creatinine of the donors were 14.3  2.0 kg and 31.4  8.2 mol/L, respectively. Ex vivo preparation of the kidneys was performed by oversewing the suprarenal aorta and vena cava with 6-0 nonabsorbable sutures. Nonrenal tributaries of the pediatric great vessels were ligated. The infrarenal donor aorta was anastomosed to the recipient external iliac artery and the infrarenal donor vena cava was sutured end-to-side to the external iliac vein using 6-0 nonabsorbable sutures. Importantly, the upper poles of the pediatric kidneys were pexed to one another when possible to avoid renal pedicle torsion. In 12 patients, two separate ureteroneocystostomies were per- formed using a modified Lich Gregoir technique. In the others, donor ureters were spatulated and conjoined prior to extravesical reimplantation. The ureteral anastomoses were stented in all but two patients. From the Multi-Organ Transplant Program (K.A.B., A.C., M.B., V.C.M., P.P.W.L.), London Health Sciences Centre, the Univer- sity of Western Ontario, London, Ontario, Canada, and Dalhou- sie University (F.B., J.L.), Halifax, Nova Scotia, Canada. Address reprint requests to Patrick P.W. Luke, London Health Sciences Centre–University Campus, 339 Windermere Road, London, Ontario Canada, N6A 5A5. E-mail: patrick.luke@lhsc.on.ca 0041-1345/03/$–see front matter © 2003 by Elsevier Inc. All rights reserved. doi:10.1016/j.transproceed.2003.08.008 360 Park Avenue South, New York, NY 10010-1710 2398 Transplantation Proceedings, 35, 2398 –2399 (2003)