Outcomes and learning curve of single-kidney transplantation from small pediatric donors in children: a retrospective cohort study with meta-analysis.

Authors

Zaohang Yan, Chengjun Yu, Jie Zhang, Meifang Wu, Xing Liu, Deying Zhang, Shengde Wu, Sheng Wen, Guanghui Wei, Yi Hua

Published in

Pediatric surgery international. Volume 42. Issue 1. Sep 06, 2026. Epub Sep 06, 2026.

Abstract

To evaluate clinical outcomes of single-kidney transplantation from small pediatric donors (weight ≤ 15 kg or age ≤ 3 years).
This retrospective cohort study included 77 children transplanted at our center (Oct 2022-May 2026): 26 small-donor vs. 51 large-donor recipients. CUSUM learning curve analysis and meta-analysis of seven studies (527 patients) were performed.
In the cohort, small-donor group had lower 1-year graft survival (73.1% vs. 100%, P < 0.001) and higher acute rejection (19.2% vs. 2.0%, P = 0.026), while thrombosis, DGF, and patient survival were similar. EGFR at 1 year was comparable between groups. CUSUM showed an inflection at Case 16 in the small-donor group, with operative time decreasing from 187.6 to 146.3 min. Meta-analysis yielded 1-year patient survival of 98%, graft survival 91%, and pooled thrombosis, DGF, and acute rejection rates of 5%, 13%, and 10%, respectively.
Early graft loss risk in small-donor single-kidney transplantation declines after the learning phase, with acceptable short-term outcomes and high organ utilization. This approach appears feasible in experienced centers, though long-term efficacy requires prospective validation.

PMID:
42701904
Bibliographic data and abstract were imported from PubMed on 07 Sep 2026.

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