The Study Of Clinical Efficacy Of Kidney Transplantation From Extremely Low Body Weight Donors

Objective:The discard rate of extremely low body weight is very high owing to the high complication rates and low graft survival rates associated with this approach.We want to demonstrate that we can transplant the kidney from extremely low body weight donor using the novel surgical method to reduce the incidence of thrombosis and improve graft survival.Methods:We retrospectively compared the results of kidney transplantation from pediatric donors at our center between January 2015 and December2019 based on the following pediatric donor criteria: donor body weight≤5 kg(n=32),5 kg< donor weight ≤20 kg(n=143),and donor weight >20kg(n=110).We also perform subgroup analysis of kidney transplantation outcomes from ≤5 kg donors,using conventional(dual separate and classic en-bloc KTx)/ novel(en-bloc KTx with outflow tract)surgical methods and allocating to adult/pediatric recipients.Results:The death-censored graft survival rates from body weight ≤5kg at 1month,and 1,3,and 5 years were 90.6%,80.9%,77.5%,and 73.9%,respectively,which were significantly lower than that from larger body weight pediatric donors.The thrombosis(18.8%)and urinary leakage(18.8%)rates were significantly higher in the donor weight ≤5 kg group.Compared with 5 kg< donor weight ≤20 kg group,donor weight ≤5kg group was at elevated risk of graft loss due to thrombosis(OR: 13.4)and acute rejection(OR: 6.7).In the donor body weight ≤5 kg group,the e GFR in 1 year in the pediatric recipient group was significantly higher than the adult recipient group,but there was no significant difference in other results.Urinary leakage rate is significantly lower in the novel operation(8.7%)than in the conventional operation group(44.4%).Conclusions:Although the outcomes of donor body weight ≤5kg kidney transplantation is inferior to that from donors with large body weight,it can be improved through surgical technique improvement.Donors with body weight ≤5 kg can be considered as an useful source to expand the donor pool.Figure 14,Table 7,References 58...