Background.Kidney transplants from small pediatric donors are considered marginal and often transplanted as dual grafts. This study aimed to compare long-term outcomes between recipients of single kidney transplants (SKTs) and dual en bloc kidney transplants (EBKTs) from small pediatric donors. Methods.Data were obtained from the Australia and New Zealand Dialysis and Transplant Registry. All adult recipients of kidney transplants from donors aged & LE;5 y were identified. The primary outcome of interest was death-censored graft survival by donor type. The secondary outcomes were early graft loss, delayed graft function, serum creatinine posttransplantation, acute rejection, and patient survival. Results.There were 183 adult recipients of kidney transplants from donors aged & LE;5 y old. Of these, 60 patients had EBKT grafts, 79 patients had SKT grafts, and 44 patients had grafts of unknown type. Compared with SKT donors, EBKT donors had lower mean age (P < 0.001) and body weight (P < 0.001). There was no significant difference in death-censored graft survival between the groups, with median survival of 23.8 y (interquartile range 21.2-25) in the EBKT cohort and 21.8 y (11.6-26.8) in the SKT cohort (hazard ratio 1.3; 95% confidence interval, 0.59-2.64; P = 0.56). EBKT grafts had lower acute rejection rates than SKT grafts (P = 0.014). There was no significant difference observed between groups with respect to early graft loss, delayed graft function, posttransplantation serum creatinine posttransplantation, or patient survival. Conclusions.EBKT and SKTs from small pediatric donors are associated with excellent long-term graft survival rates.

Some patients called for kidney transplantation are anticoagulated with warfarin for indications such as antiphospholipid syndrome, where the risk of thrombosis with reversal may be high. Traditionally, the approach has been reversal of warfarin and treatment perioperatively with intravenous unfractionated heparin. However, this may be complicated by either thrombosis or bleeding if the heparin dose is incorrect. We report the case of a peritoneal dialysis patient warfarinized for antiphospholipid syndrome who was successfully transplanted with an international normalized ratio of 2.1 with neither thrombosis nor bleeding. This may be an alternative to heparin for patients in whom anticoagulation must be maintained.