Successful En Bloc Renal Transplantation from a 9-Month-Old Deceased Donor: Technical Feasibility in a Resource-Limited Setting

Abstract

Infant donors aged less than 1 year account for <2% of India’s deceased donor pool because of technical complexity and concerns regarding vascular thrombosis, and most centers, therefore, maintain informal lower age limits of 5 years. We report successful en bloc transplantation of kidneys retrieved from a 9-month-old, 7-kg, blood group B+ female donor into a 10-year-old, 20-kg, blood group B+ female recipient with end-stage renal disease, giving a donor–recipient weight ratio of 1:2.86. Standard en bloc back-table preparation was performed, including creation of an inferior vena cava branch patch. The donor aorta was anastomosed end-to-side to the recipient’s right common iliac artery, and the donor vena cava was anastomosed to the recipient’s iliac vein. The right graft ureter was implanted into the bladder using a modified Lich–Gregoir technique over a stent, whereas the left graft ureter was anastomosed to the native right ureter over a stent. Cold ischemia time, defined from donor aortic cross-clamp/cold perfusion to graft removal from ice immediately before implantation, was 4 h 15 min; warm ischemia time was 28 min. Immediate graft function occurred, with urine output of 300 mL within 30 min and 3670 mL on postoperative day 1. Serial Doppler ultrasonography showed good perfusion, normal resistive indices, and no vascular thrombosis. Serum creatinine level decreased from 5.3 mg/dL preoperatively to 0.67–0.68 mg/dL by postoperative days 6–11. Postoperative issues included severe hypertension, transient wound ooze, fluid overload with ascites, and transient neuropraxia. The patient was discharged with stable graft function on triple immunosuppression.