One kidney can do the job in adults

An adult who receives a single kidney from a deceased donor younger than 5 years old is likely to fare just as well in the long run as an adult who receives kidneys from older children.

If a kidney donor is younger than 5 years and the recipient is an adult, both kidneys are usually transplanted based on the belief that one small kidney would not be sufficient in an adult. Technically, it's very challenging to 'split' the kidneys from these babies, often so difficult that some programmes don't even use them en bloc - but just discard them. Determining the minimum donor age or body weight for splitting kidneys for transplant is controversial. However, giving each of two patients in need one organ from the same donor could increase kidney transplants.

Researchers in America compared the outcomes of 40 adult recipients of single kidneys from donors younger than age 5 and 39 adult recipients of kidneys from donors aged 5 to 10 years. As expected, the kidneys in the younger donor group were significantly smaller than those in the older donor group.

While ureteral stents - tubes inserted to help drain urine from the kidney - were required more often in the younger donor group (73 percent versus 38 percent), complications that required additional surgery were similar in the two groups. Moreover, patients in the two groups experienced similar rates of kidney rejection and delayed kidney function. In both groups, kidney function improved significantly in the first year after transplant, and continued to improve into the third year post-transplant. Furthermore, patients in the two groups lived a similar length of time.

The researchers concluded that single paediatric kidney transplants from donors who are younger than 5 years can be used with acceptable complications and good long-term outcomes as those from older paediatric donors.