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2017 ; 3
(3
): e130
Nephropedia Template TP
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English Wikipedia
En Bloc Cadaver Kidney Transplantation From a 9-Month-Old Donor to an Adult
Recipient: Maturation of Glomerular Size and Podocyte in the Recipient
#MMPMID28361114
Hirukawa T
; Suzuki H
; Niimura F
; Fukagawa M
; Kakuta T
Transplant Direct
2017[Mar]; 3
(3
): e130
PMID28361114
show ga
BACKGROUND: Favorable outcomes of en bloc pediatric donor kidney transplantation
to adult recipients are attributed primarily to grafting of twice the nephron
mass of a single kidney. METHODS: The kidneys of a 9-month-old male infant were
transplanted en bloc in a 56-year-old man. Biopsies were performed 1 hour
postreperfusion, 6 months and 3.5 years posttransplant. RESULTS: Warm and cold
ischemia times were 21 and 426 minutes, respectively. The recipient was released
from hemodialysis 10 days posttransplant and discharged 91 days posttransplant
when serum creatinine was 0.9 mg/dL. At 4 years and 9 months posttransplant,
serum creatinine was 1.0 mg/dL, and estimated glomerular filtration rate was 58.0
mL/min per 1.73 m(2). The grafts increased in size until they reached adult size
by 3 months posttransplant. The glomerular area and volume, respectively,
increased from 5.9 × 10(3) ?m(2) and 0.34 × 10(6) ?m(3) at 1 hour postreperfusion
to 14.9 × 10(3) ?m(2) and 1.27 × 10(6) ?m(3) at 3.5 years posttransplant, both of
which were less than half of adult size. At 1 hour postreperfusion, podocytes
were structurally immature. At 6 months posttransplant, podocyte immaturity was
still evident. At 3.5 years posttransplant, podocytes were mature. CONCLUSIONS:
These findings suggest that podocytes and glomerular size of pediatric donor
kidneys can continue to mature in adult recipients at rates appropriate for donor
age when transplanted en bloc. The maturational levels of podocytes and glomeruli
may also be a factor involved in favorable outcomes of en bloc pediatric donor
kidney transplantation.