Background: Because of the donor organ shortage, kidneys from smaller pediatric donors are being increasingly used. However, it is unclear whether small pediatric deceased donor kidneys should be used as single grafts or en bloc. We reviewed our outcomes of single kidney transplants from small pediatric donors into adult recipients. Methods: Kidneys equal to or more than 6 cm in length were transplanted as a single kidney in seven adult recipients weighing less than 80 kg. Creatinine clearance, kidney graft size, and glomerular size were followed up at 1, 3, 6, and 12 months after transplantation. Results: All patients and grafts, with the exception of one patient, are currently alive with functional grafts. Two kidneys were procured after cardiac death of the donors, but no delayed graft function was observed. A total of 57% (four of seven) patients developed BK viremia, and 29% (two of seven) patients developed BK virus nephropathy. The graft size significantly increased during follow-up by ultrasonography (P=0.02). The renal allograft function by calculated creatinine clearance also significantly improved at 40.6±6.9 mL/min, 52.7±10.2 mL/min, and 66.2±9.7 mL/min at 1, 3, and 12 month after transplantation, respectively (P=0.01). The size of glomeruli significantly increased from 122±8.4 μm at 1 to 2 months to 169±22.5 μm at 3 to 12 months after transplantation (P<0.01). Conclusions: Kidneys equal to or more than 6 cm from small pediatric donors can be successfully transplanted as a single kidney. Single pediatric kidney transplantation can provide adequate renal function with a speedy increase in allograft size.
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