Pediatric Nephrology

, Volume 33, Issue 6, pp 1057–1068 | Cite as

Outcome of renal transplantation in small infants: a match-controlled analysis

  • Marcus Weitz
  • Guido F. Laube
  • Maria Schmidt
  • Kai Krupka
  • Luisa Murer
  • Dominik Müller
  • Bernd Hoppe
  • Anja Büscher
  • Jens König
  • Martin Pohl
  • Therese Jungraithmayr
  • Florian Thiel
  • Heiko Billing
  • Ryszard Grenda
  • Jacek Rubik
  • Michael M. Kaabak
  • Fatos Yalcinkaya
  • Rezan Topaloglu
  • Nicholas Webb
  • Luca  Dello Strologo
  • Lars Pape
  • Silvio Nadalin
  • Burkhard Tönshoff
Original Article
Part of the following topical collections:
  1. What’s New in Renal Transplantation



Infants with a body weight of less than 10 kg are often not considered to be suitable candidates for renal transplantation (RTx). The objective of this study was to evaluate this arbitrary weight threshold for pediatric RTx.


We conducted a multicenter, retrospective, match-controlled cohort study on infants weighing less than 10 kg at time of engrafting (low-weight group [LWG], n = 38) compared to a matched control group (n = 76) with a body weight of 10–15 kg, using data from the first 2 years post-transplant derived from the CERTAIN Registry.


Patient survival was 97 and 100% in the LWG and control groups, respectively (P = 0.33), and death-censored graft survival was 100 and 95% in the LWG and control groups, respectively (P = 0.30). Estimated glomerular filtration rate at 2 years post-transplant was excellent and comparable between the groups (LWG 77.6 ± 34.9 mL/min/1.73 m2; control 74.8 ± 29.1 mL/min/1.73 m2; P = 0.68). The overall incidences of surgery-related complications (LWG 11%, control 23%; P = 0.12) and medical outcome measures (LWG 23%, control 36%, P = 0.17) were not significantly different between the groups. The medical outcome measures included transplant-related viral diseases (LWG 10%, control 21%; P = 0.20), acute rejection episodes (LWG 14%, control 29%; P = 0.092), malignancies (LWG 3%, control 0%; P = 0.33) and arterial hypertension (LWG 73%, control 67%; P = 0.57).


These data suggest that RTx in low-weight children is a feasible option, at least in selected centers with appropriate surgical and medical expertise.


Renal transplantation Infants Children Surgical complications Medical complications 



We gratefully acknowledge the support of the CERTAIN Registry through a grant from the Dietmar Hopp Stiftung and through grants from the pharmaceutical companies Astellas and Novartis.


Study design, performance of the study, data analysis and writing of the manuscript: Marcus Weitz, Maria Schmidt, Silvio Nadalin, Guido F. Laube, Kai Krupka and Burkhard Tönshoff. Data collection and critical revision of the manuscript: Dominik Müller, Bernd Hoppe, Anja Büscher, Jens Koenig, Martin Pohl, Theresa Jungraithmayr, Florian Thiel, Lars Pape, Heiko Billing, Luisa Murer, Luca Dello Strologo, Jacek Rubik, Ryszard Grenda, Michael M. Kaabak, Rezan Topaloglu, Fatos Yalcinkaya, Nicholas Webb. All authors reviewed the manuscript, believed it represents valid work and approved it for submission.


The CERTAIN Registry is funded by a grant from the Dietmar Hopp Stiftung and grants from the pharmaceutical companies Astellas and Novartis.

Compliance with ethical standards

Conflict of interest statement

Marcus Weitz has participated on an Advisory Board for Astellas and has received lecture fees from Alexion. Burkhard Tönshoff has received research grants, travel grants and lecture fees and participated in advisory boards of Astellas, Bristol-Myers Squibb, Novartis and Roche. Heiko Billing has received travel grants by Astellas. Lars Pape has received research grants, travel grants and lecture fees, participated in advisory boards of Astellas and Novartis and has received research grants and travel grants from Sanofi. Michael Kabaak received research grants and lecture fees and participated in the advisory board of Astellas and Alexion. Luca DelloStrologo has received lecture fees from Novartis. Nicholas Webb participated on Advisory Boards for Abbvie, Astellas, Alexion and Raptor. The other contributing authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Written informed consent to participate in the registry was obtained by all parents or guardians and patients when appropriate for their age.

Supplementary material

467_2018_3895_MOESM1_ESM.docx (15 kb)
ESM 1 (DOCX 14 kb)
467_2018_3895_MOESM2_ESM.docx (91 kb)
ESM 2 (DOCX 91 kb)


  1. 1.
    McDonald SP, Craig JC, Australian, New Zealand Paediatric Nephrology A (2004) Long-term survival of children with end-stage renal disease. N Engl J Med 350(26):2654–2662CrossRefPubMedGoogle Scholar
  2. 2.
    Dharnidharka VR, Fiorina P, Harmon WE (2014) Kidney transplantation in children. N Engl J Med 371(6):549–558CrossRefPubMedGoogle Scholar
  3. 3.
    Neipp M, Offner G, Luck R, Latta K, Strehlau J, Schlitt HJ, Ehrich JH, Klempnauer J, Nashan B (2002) Kidney transplant in children weighing less than 15 kg: donor selection and technical considerations. Transplantation 73(3):409–416CrossRefPubMedGoogle Scholar
  4. 4.
    Briscoe DM, Kim MS, Lillehei C, Eraklis AJ, Levey RH, Harmon WE (1992) Outcome of renal transplantation in children less than two years of age. Kidney Int 42(3):657–662CrossRefPubMedGoogle Scholar
  5. 5.
    van der Heijden BJ, van Dijk PC, Verrier-Jones K, Jager KJ, Briggs JD (2004) Renal replacement therapy in children: data from 12 registries in Europe. Pediatr Nephrol 19(2):213–221CrossRefPubMedGoogle Scholar
  6. 6.
    Gillen DL, Stehman-Breen CO, Smith JM, McDonald RA, Warady BA, Brandt JR, Wong CS (2008) Survival advantage of pediatric recipients of a first kidney transplant among children awaiting kidney transplantation. Am J Transplant 8(12):2600–2606CrossRefPubMedGoogle Scholar
  7. 7.
    Becker T, Neipp M, Reichart B, Pape L, Ehrich J, Klempnauer J, Offner G (2006) Paediatric kidney transplantation in small children-- a single centre experience. Transpl Int 19(3):197–202CrossRefPubMedGoogle Scholar
  8. 8.
    Plotnicki L, Kohl CD, Hocker B, Krupka K, Rahmel A, Pape L, Hoyer P, Marks SD, Webb NJ, Soylemezoglu O, Topaloglu R, Szabo AJ, Seeman T, Marlies Cornelissen EA, Knops N, Grenda R, Tonshoff B (2013) The CERTAIN registry: a novel, web-based registry and research platform for pediatric renal transplantation in Europe. Transplant Proc 45(4):1414–1417CrossRefPubMedGoogle Scholar
  9. 9.
    Schwartz GJ, Munoz A, Schneider MF, Mak RH, Kaskel F, Warady BA, Furth SL (2009) New equations to estimate GFR in children with CKD. J Am Soc Nephrol 20(3):629–637CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Neuhauser H, Thamm M (2007) Blood pressure measurement in the German health interview and examination survey for children and adolescents (KiGGS). Methodology and initial results. Bundesgesundheitsbl Gesundheitsforsch Gesundheitsschutz 50(5–6):728–735CrossRefGoogle Scholar
  11. 11.
    Solez K, Colvin RB, Racusen LC, Haas M, Sis B, Mengel M, Halloran PF, Baldwin W, Banfi G, Collins AB, Cosio F, David DS, Drachenberg C, Einecke G, Fogo AB, Gibson IW, Glotz D, Iskandar SS, Kraus E, Lerut E, Mannon RB, Mihatsch M, Nankivell BJ, Nickeleit V, Papadimitriou JC, Randhawa P, Regele H, Renaudin K, Roberts I, Seron D, Smith RN, Valente M (2008) Banff 07 classification of renal allograft pathology: updates and future directions. Am J Transplant 8(4):753–760CrossRefPubMedGoogle Scholar
  12. 12.
    Loupy A, Haas M, Solez K, Racusen L, Glotz D, Seron D, Nankivell BJ, Colvin RB, Afrouzian M, Akalin E, Alachkar N, Bagnasco S, Becker JU, Cornell L, Drachenberg C, Dragun D, de Kort H, Gibson IW, Kraus ES, Lefaucheur C, Legendre C, Liapis H, Muthukumar T, Nickeleit V, Orandi B, Park W, Rabant M, Randhawa P, Reed EF, Roufosse C, Seshan SV, Sis B, Singh HK, Schinstock C, Tambur A, Zeevi A, Mengel M (2017) The Banff 2015 kidney meeting report: current challenges in rejection classification and prospects for adopting molecular pathology. Am J Transplant 17(1):28–41CrossRefPubMedGoogle Scholar
  13. 13.
    Haas M (2016) The revised (2013) Banff classification for antibody-mediated rejection of renal allografts: update, difficulties, and future considerations. Am J Transplant 16(5):1352–1357CrossRefPubMedGoogle Scholar
  14. 14.
    Neuhauser H, Schienkiewitz A, Schaffrath Rosario A, Dortschy R, Kurth BM (2013) Referenzperzentile für anthropometrische Maßzahlen und Blutdruck aus der Studie zur Gesundheit von Kindern und Jugendlichen in Deutschland (KiGGS) 2003–2006. Editor: Robert-Koch-Institut, BerlinGoogle Scholar
  15. 15.
    Humar A, Michaels M, Monitoring AIWGoID (2006) American Society of Transplantation recommendations for screening, monitoring and reporting of infectious complications in immunosuppression trials in recipients of organ transplantation. Am J Transplant 6(2):262–274CrossRefPubMedGoogle Scholar
  16. 16.
    Kotton CN, Kumar D, Caliendo AM, Asberg A, Chou S, Danziger-Isakov L, Humar A, Transplantation Society International CMVCG (2013) Updated international consensus guidelines on the management of cytomegalovirus in solid-organ transplantation. Transplantation 96(4):333–360CrossRefPubMedGoogle Scholar
  17. 17.
    Campo E, Swerdlow SH, Harris NL, Pileri S, Stein H, Jaffe ES (2011) The 2008 WHO classification of lymphoid neoplasms and beyond: evolving concepts and practical applications. Blood 117(19):5019–5032CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Hirsch HH, Randhawa P; AST Infectious Diseases Community of Practice (2013) BK polyomavirus in solid organ transplantation. Am J Transplant 13(Suppl 4):179–188Google Scholar
  19. 19.
    Donders AR, van der Heijden GJ, Stijnen T, Moons KG (2006) Review: a gentle introduction to imputation of missing values. J Clin Epidemiol 59(10):1087–1091CrossRefPubMedGoogle Scholar
  20. 20.
    Rana A, Brewer ED, Scully BB, Kueht ML, Goss M, Halazun KJ, Liu H, Galvan NT, Cotton RT, O'Mahony CA (2017) Poor outcomes for children on the wait list at low-volume kidney transplant centers in the United States. Pediatr Nephrol 32(4):669–678CrossRefPubMedGoogle Scholar
  21. 21.
    R Core Team (2014) R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna. Available at:
  22. 22.
    Harrell FE Jr. (2016) rms: Regression Modeling Strategies. R package version 4.5–0. Available at:
  23. 23.
    Bates D, Mächler M, Bolker BB, Walker S (2015) Fitting linear mixed-effects models using lme4. J Stat Softw 67(1):1–48CrossRefGoogle Scholar
  24. 24.
    Tyden G, Berg U, Bohlin AB, Sandberg J (1997) Renal transplantation in children less than two years old. Transplantation 63(4):554–558CrossRefPubMedGoogle Scholar
  25. 25.
    McDonald RA, Smith JM, Stablein D, Harmon WE (2003) Pretransplant peritoneal dialysis and graft thrombosis following pediatric kidney transplantation: a NAPRTCS report. Pediatr Transplant 7(3):204–208CrossRefPubMedGoogle Scholar
  26. 26.
    Singh A, Stablein D, Tejani A (1997) Risk factors for vascular thrombosis in pediatric renal transplantation: a special report of the north American pediatric renal transplant cooperative study. Transplantation 63(9):1263–1267CrossRefPubMedGoogle Scholar
  27. 27.
    Bakir N, Sluiter WJ, Ploeg RJ, van Son WJ, Tegzess AM (1996) Primary renal graft thrombosis. Nephrol Dial Transplant 11(1):140–147CrossRefPubMedGoogle Scholar
  28. 28.
    Nagra A, Trompeter RS, Fernando ON, Koffman G, Taylor JD, Lord R, Hutchinson C, O'Sullivan C, Rees L (2004) The effect of heparin on graft thrombosis in pediatric renal allografts. Pediatr Nephrol 19(5):531–535CrossRefPubMedGoogle Scholar
  29. 29.
    Ball CG, Kirkpatrick AW, Yilmaz S, Monroy M, Nicolaou S, Salazar A (2006) Renal allograft compartment syndrome: an underappreciated postoperative complication. Am J Surg 191(5):619–624CrossRefPubMedGoogle Scholar
  30. 30.
    Furness PD 3rd, Houston JB, Grampsas SA, Karrer FM, Firlit CF, Koyle MA (2001) Extraperitoneal placement of renal allografts in children weighing less than 15 kg. J Urol 166(3):1042–1045CrossRefPubMedGoogle Scholar
  31. 31.
    Carlier M, Squifflet JP, Pirson Y, Gribomont B, Alexandre GP (1982) Maximal hydration during anesthesia increases pulmonary arterial pressures and improves early function of human renal transplants. Transplantation 34(4):201–204CrossRefPubMedGoogle Scholar
  32. 32.
    Heylen L, Pirenne J, Samuel U, Tieken I, Naesens M, Sprangers B, Jochmans I (2017) The impact of anastomosis time during kidney transplantation on graft loss: a Eurotransplant cohort study. Am J Transplant 17(3):724–732CrossRefPubMedGoogle Scholar
  33. 33.
    Routh JC, Yu RN, Kozinn SI, Nguyen HT, Borer JG (2013) Urological complications and vesicoureteral reflux following pediatric kidney transplantation. J Urol 189(3):1071–1076CrossRefPubMedGoogle Scholar
  34. 34.
    Ghirardo G, Midrio P, Zucchetta P, Gamba P, Zanon G, Murer L, Castagnetti M (2015) Renal transplantation in children weighing <15 kg: does concomitant lower urinary tract dysfunction influence the outcome? Pediatr Nephrol 30(8):1337–1342CrossRefPubMedGoogle Scholar
  35. 35.
    Thomas MC, Mathew TH, Russ GR, Rao MM, Moran J (2003) Perioperative blood pressure control, delayed graft function, and acute rejection after renal transplantation. Transplantation 75(12):1989–1995CrossRefPubMedGoogle Scholar
  36. 36.
    Spatenka J, Seeman T, Foltynova E, Burkert J, Dusek J, Vondrak K, Janda J, Habrmanova A, Krejcova J, Matousovic K (2012) Effect of donor/recipient body weight ratio, donor weight, recipient weight and donor age on kidney graft function in children. Nephrol Dial Transplant 27(2):820–824CrossRefPubMedGoogle Scholar
  37. 37.
    Perico N, Cattaneo D, Sayegh MH, Remuzzi G (2004) Delayed graft function in kidney transplantation. Lancet 364(9447):1814–1827CrossRefPubMedGoogle Scholar
  38. 38.
    Kasiske BL, Gaston RS, Gourishankar S, Halloran PF, Matas AJ, Jeffery J, Rush D (2005) Long-term deterioration of kidney allograft function. Am J Transplant 5(6):1405–1414CrossRefPubMedGoogle Scholar
  39. 39.
    Dale-Shall AW, Smith JM, McBride MA, Hingorani SR, McDonald RA (2009) The relationship of donor source and age on short- and long-term allograft survival in pediatric renal transplantation. Pediatr Transplant 13(6):711–718CrossRefPubMedGoogle Scholar
  40. 40.
    Matas AJ, Smith JM, Skeans MA, Thompson B, Gustafson SK, Schnitzler MA, Stewart DE, Cherikh WS, Wainright JL, Snyder JJ, Israni AK, Kasiske BL (2014) OPTN/SRTR 2012 annual data report: kidney. Am J Transplant 14[Suppl 1]:11–44CrossRefPubMedGoogle Scholar
  41. 41.
    Pescovitz MD (2010) Valganciclovir: recent progress. Am J Transplant 10(6):1359–1364CrossRefPubMedGoogle Scholar
  42. 42.
    Dharnidharka VR, Abdulnour HA, Araya CE (2011) The BK virus in renal transplant recipients—review of pathogenesis, diagnosis, and treatment. Pediatr Nephrol 26(10):1763–1774CrossRefPubMedGoogle Scholar
  43. 43.
    Smith JM, McDonald RA, Finn LS, Healey PJ, Davis CL, Limaye AP (2004) Polyomavirus nephropathy in pediatric kidney transplant recipients. Am J Transplant 4(12):2109–2117CrossRefPubMedGoogle Scholar
  44. 44.
    Hocker B, Weber LT, Feneberg R, Drube J, John U, Fehrenbach H, Pohl M, Zimmering M, Frund S, Klaus G, Wuhl E, Tonshoff B (2010) Improved growth and cardiovascular risk after late steroid withdrawal: 2-year results of a prospective, randomised trial in paediatric renal transplantation. Nephrol Dial Transplant 25(2):617–624CrossRefPubMedGoogle Scholar
  45. 45.
    Benfield MR, Bartosh S, Ikle D, Warshaw B, Bridges N, Morrison Y, Harmon W (2010) A randomized double-blind, placebo controlled trial of steroid withdrawal after pediatric renal transplantation. Am J Transplant 10(1):81–88CrossRefPubMedGoogle Scholar
  46. 46.
    Danzinger-Isakov L, Kumar D, Practice ASTIDCo (2009) Guidelines for vaccination of solid organ transplant candidates and recipients. Am J Transplant 9[Suppl 4]:S258–S262CrossRefPubMedGoogle Scholar
  47. 47.
    Verma A, Wade JJ (2006) Immunization issues before and after solid organ transplantation in children. Pediatr Transplant 10(5):536–548CrossRefPubMedGoogle Scholar
  48. 48.
    Benson K, Hartz AJ (2000) A comparison of observational studies and randomized, controlled trials. N Engl J Med 342(25):1878–1886CrossRefPubMedGoogle Scholar

Copyright information

© IPNA 2018

Authors and Affiliations

  • Marcus Weitz
    • 1
  • Guido F. Laube
    • 1
  • Maria Schmidt
    • 1
  • Kai Krupka
    • 2
  • Luisa Murer
    • 3
  • Dominik Müller
    • 4
  • Bernd Hoppe
    • 5
  • Anja Büscher
    • 6
  • Jens König
    • 7
  • Martin Pohl
    • 8
  • Therese Jungraithmayr
    • 9
  • Florian Thiel
    • 10
  • Heiko Billing
    • 11
  • Ryszard Grenda
    • 12
  • Jacek Rubik
    • 12
  • Michael M. Kaabak
    • 13
  • Fatos Yalcinkaya
    • 14
  • Rezan Topaloglu
    • 15
  • Nicholas Webb
    • 16
  • Luca  Dello Strologo
    • 17
  • Lars Pape
    • 18
  • Silvio Nadalin
    • 19
  • Burkhard Tönshoff
    • 2
  1. 1.Paediatric NephrologyUniversity Children‘s Hospital ZurichZurichSwitzerland
  2. 2.Department of Paediatrics IUniversity Children’s HospitalHeidelbergGermany
  3. 3.Paediatric Nephrology Dialysis and Transplant Unit, Department of Woman’s and Child’s HealthAzienda Ospedaliera–University of PadovaPadovaItaly
  4. 4.Paediatric NephrologyCharité Campus Virchow HospitalBerlinGermany
  5. 5.University Children’s HospitalBonnGermany
  6. 6.University Children’s HospitalEssenGermany
  7. 7.University Children’s HospitalMünsterGermany
  8. 8.Department of General Pediatrics, Adolescent Medicine and NeonatologyMedical Center - University Freiburg, Faculty of MedicineFreiburgGermany
  9. 9.Department of Paediatric NephrologyChildren’s HospitalMemmingenGermany
  10. 10.University Children’s HospitalHamburg–EppendorfGermany
  11. 11.Paediatrics IUniversity Children’s HospitalTübingenGermany
  12. 12.Department of Nephrology, Kidney Transplantation and Arterial HypertensionChildren’s Memorial Health InstituteWarsawPoland
  13. 13.Boris Petrovsky National Research Centre of SurgeryMoscowRussia
  14. 14.Department of Paediatric Nephrology, Faculty of MedicineAnkara UniversityAnkaraTurkey
  15. 15.Department of Paediatric Nephrology, Faculty of MedicineHacettepe UniversityAnkaraTurkey
  16. 16.Department of Paediatric Nephrology and NIHR Manchester Clinical Research FacilityUniversity of Manchester–Manchester Academic Health Science CentreManchesterUK
  17. 17. Renal Transplantation Unit, Bambino Gesù Children’s Hospital (OPBG)Institute for Scientific ResearchRomeItaly
  18. 18.Department of Paediatric NephrologyHannover Medical SchoolHannoverGermany
  19. 19.Department of General, Visceral and Transplant SurgeryUniversity Hospital TübingenTübingenGermany

Personalised recommendations