Pape L et al. (2006) Superior long-term graft function and better growth of grafts in children receiving kidneys from paediatric compared with adult donors. Nephrol Dial Transplant 21: 2596–2600

Pediatric donor kidneys are frequently not allocated to children because a number of historical studies have indicated that these grafts are less likely to survive than grafts from adult donors. Conversely, other studies have shown that the glomerular filtration rate of renal allografts from adult donors drops following transplantation into a pediatric recipient, and subsequently fails to increase as the child grows.

Researchers at the Medical School of Hannover, Germany, followed 99 white children (mean age 5.5 years) who received a first cadaveric kidney transplant during the period 1990–2005; 60 children received a graft from an adult donor (mean age 36 years) and 39 received a kidney from a pediatric donor (mean age 9 years). During the first 15 years of follow-up (mean follow-up period 5.9 years) no difference in graft survival was noted between the two groups. Grafts from pediatric donors, although smaller at the time of transplantation, increased in size following the procedure, and reached volumes similar to those of kidneys from adult donors within 3 years. The estimated glomerular filtration rates, adjusted to recipient body surface areas, of grafts from pediatric donors were considerably higher 3–5 years after transplantation than those of organs donated by adults.

The investigators suggest that renal allografts from pediatric donors over 2 years of age should be preferentially allocated to pediatric recipients matched for age and body size.