Expanding the Envelope: Favorable Outcomes Utilizing Kidneys From Small Pediatric Donors (≤ 15 kg).

BACKGROUND: Utilization of kidneys from small pediatric donors (SPDs ≤ 15 kg) is limited. Decisions to split and use the kidneys for 2 recipients remain controversial. METHODS: Retrospective single-center study aimed primarily at evaluating graft loss within 30 days after transplant using SPD kidneys. Recipients were divided into group A (donor weight < 10 kg, n = 24) and group B (≥ 10 kg, n = 16). RESULTS: Forty transplants were performed with 100% patient survival. Mean follow-up was 402 days, overall graft survival was 95%, with 91.7% and 100% in groups A and B, respectively (P = .24). Mean recipient-to-donor weight ratio (RTDWR) was higher in group A (10.5 vs 6.3, P < .001). Surgical complications were similar between the groups. These were more common with en bloc compared to single implantation (P = .05), and RTDWR was the main predictor (P = .005). Graft function was similar between the groups; mean 12-month creatinine was 1.2 mg % and eGFR was 58.2 mL/min/1.73 m2. Sixteen out of 38 patients developed proteinuria (42%) with no difference among subgroups, although male recipients were at a higher risk (OR = 8.4 [95% CI 1.5-46.1], P = .014); 83% responded to therapy. CONCLUSION: Utilization and early splitting of SPD kidneys yields favorable graft survival and function irrespective of donor weight and age. Early splitting should be considered.

Single center observation of the role of pre-existing HLA-DP antibodies in humoral rejection following renal transplantation.

HLA antigens, including HLA-A, B, C, DR and DQ have long been known to have an effect on transplant outcome. Presence of antibodies to these antigens is detrimental to transplant outcome as it ends up to either acute or chronic humoral rejection depending on the titer of the antibodies to these antigens. However, the role of HLA-DP is not fully clear, predominantly due to lack of adequate publications and the fact that DP antigen and antibody detection became possible with the advent of new beads technology. As a results, allocation system has not yet included HA-DP antibodies in virtual crossmatching. This report presents two novel cases with strong HLA-DP antibodies which resulted in acute humoral rejection (AMR).