En-bloc kidney transplantation in the United States: An analysis of United Network of Organ Sharing (UNOS) data from 1987 to 2003

With increasing donor organ shortages, en-bloc kidney (EBK) transplantation is an alternative to utilize very young or very old donor age cadaver kidneys for transplantation. Several single-center series have reported excellent graft survival (GS). We sought to determine national level registry-based patterns for GS and determine adjusted hazard ratios (AHR) for graft loss after EBK versus single kidney (SK) cadaver transplants. Data reported to UNOS from 1987 to 2003 were analyzed using PHREG (SAS version 8.1) statistical procedures. Proportional hazards models were constructed that included multiple donor, recipient and surgical variables. Of the 2160 EBK transplants reported, 77% were from donors < 5 years of age. EBK transplants had superior GS to SK transplants, when donor age was restricted to < 5 years (AHR 0.708, p < 0.001). GS at 1, 3 and 5 years post-transplant was superior with EBK (85%, 76% and 71%) versus SK (81%, 68%, 63% and p < 0.001 at all time points). EBK transplants from very young donors were associated with a significantly lower rate of delayed graft function than SK transplants (17.9% versus 23.4%, p < 0.001). National registry data suggest that EBK transplants present a viable option for transplantation of very young donor kidneys.