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Case Reports
. 2023 Oct;38(10):3489-3492.
doi: 10.1007/s00467-023-05901-5. Epub 2023 Mar 16.

Deceased donor kidney transplanted in childhood functioning well after 52 years

Giuseppina Spartà #  1 , Karine Hadaya #  2 , Luc Paunier  3 , Eric Girardin  3 , Ernst Leumann  4
Affiliations
Case Reports

Deceased donor kidney transplanted in childhood functioning well after 52 years

Giuseppina Spartà et al. Pediatr Nephrol. 2023 Oct.

Abstract

Background: Kidney transplantation in children in 1970 was considered by many to be unethical, as long-term survival was minimal. It was therefore risky at the time to offer transplantation to a child.

Case diagnosis/treatment: A 6-year-old boy with kidney failure due to haemolytic uraemic syndrome received 4 months of intermittent peritoneal dialysis followed by 6 months of haemodialysis until at 6 years and 10 months, he underwent bilateral nephrectomy and received a kidney transplant from a deceased 18-year-old donor. Despite moderate long-term immunosuppression of prednisone (20 mg/48 h) and azathioprine (62.5 mg/day), at the last visit in September 2022, he was well, normotrophic, with a serum creatinine of 157 µmol/l (eGFR 41 ml/min/1.73 m2) and no haematuria, proteinuria or hypertension. Except for benign skin lesions due to azathioprine, and undergoing an aortic valve replacement and an aortic aneurysm repair in adulthood, the now 58-year-old man has had no major complications.

Conclusions: We speculate that stable and unmodified immunosuppressive therapy, started before the era of calcineurin inhibitors, the lack of significant rejection episodes, the absence of donor-specific antibodies, and the young donor age have contributed to maintaining exceptional long-term kidney transplant survival. Luck, a robust health system and an adherent patient are also important. To the best of our knowledge, this is the longest functioning kidney transplant from a deceased donor performed in a child worldwide. Despite its risky nature at the time, this transplant paved the way for others.

Keywords: Child; Dialysis; Haemolytic uraemic syndrome; Kidney transplantation; Long-term survival; Paediatric.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
The 6½-year-old patient on haemodialysis in 1970. Not shown is the tank containing 240-l of dialysate. A 6-plate dialyser was used (reduced surface area for a child). Ultrafiltration was very limited; the child had a severe fluid restriction of 500 ml/day
See this image and copyright information in PMC

References

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