Boyle, S

Copley, A

Gaymer, C

Hayes, WN

Kessaris, N

Knapp, K

Mamode, N

Marks, SD

Scanes, M

Tanton, J

UCL Discovery

Living related renal transplantation from grandparental donors to paediatric recipientsStephen MarksM Scanes, J Tanton, K Knapp, A Copley, C Gaymer, S Boyle, W Hayes, N Kessaris, N MamodeGreat Ormond Street Hospital for Children  and UCL GOS Institute of Child Health, London, UKIPTA 9th Congress, Barcelona, 29 May 2017Case history• 10 year old girl– ESKD on PD ?cause• Maternal grandfather  aged 50 years• Out of centre referral  as donor multiple vessels – 3 R + 3 L renal arteries • UTI at 1 month• PCr = 56 (eGFR = 95)Paediatric recipients• 7 children – between 8 September 2009 and 2 May 2017– 4 girls (57%); 3 boys (43%)– PCr = 353 - 526µmol/l; 2 retransplanted– aged 2.1 - 11.7 (median 6.9) years at transplant– weight of 10.8 - 46.9 (median 16.8) kg• 4 INTRAPERITONEAL (UNDER 20kg)– 4 outside referrals of complex cases• 2 COMPLEX RECIPIENTS “UNTRANSPLANTABLE”• 1 COMPLEX DONOR ANATOMYCause of ESKDPUV = 1Cloaca=1Modalities of ESKDGrandparental donors• 5 grandmothers (71%)• 2 grandfathers (29%)– aged = 45 - 56  (median 50) years– eGFR = 72 - 89 (median 84) mls/min– all blood group compatible:• 4 O DONORS TO O RECIPIENTS• 3 O DONORS TO A RECIPIENTSMismatchesWhy did the grandparents donate ?• 2 families wanted to use parents for subsequent LRD in future• 2 psychosocial issues– father in prison, mother drug addiction, child protection issues and child cared for by grandmother (donor)– mother psychological issues, father absent; child cared for by grandmother (donor)• 2 patients had failed parental LRD– other parent medically unsuitable• 1 parent medically unsuitable; absent fatherRecipient follow up• Post-transplant follow-up– 1.0 months - 7.5 years (median 2.8 years)• 100% patient survival• 86% renal allograft survival– retroviral disease• Good renal allograft function– plasma creatinine of 56 - 92µmol/l– eGFR of 52 - 83mls/min/1.73m2No acute rejection episodes• 4 biopsies performed in 3 patients– no rejection– mild chronic changesConclusions• Excellent patient and renal allograft survival with grandparental donors• Improved outcomes– psychosocial input– post-transplant psychological evaluation

Living related renal transplantation from grandparental donors to paediatric recipients

http://discovery.ucl.ac.uk/10068738/2/Scanes_MARKS%20Grandparents%20IPTA%20May17.pdf

Living related renal transplantation from grandparental donors to paediatric recipients

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