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With such a large disparity between the supply of organs and demand, new options for kidney transplant are essential to save lives. Kidney exchanges and incompatible blood-type desensitization are options for transplant, but few hospitals perform pediatric en-bloc kidney transplants, which involve donated kidneys from a deceased toddler. 

Barnes-Jewish Hospital kidney transplant surgical director Jason Wellen, MD, has been performing pediatric en-bloc kidney transplants in adults since he joined the St. Louis hospital in 2007. “It is critical to find new ways to open the donor pool and get patients transplanted,” he says. “Our options for kidney transplant patients include access to some of the largest nationwide kidney exchanges, blood-type desensitization and pediatric en-bloc transplants.” 

Two studies recently released show that en-bloc kidney transplants actually exceed average survival rates. The 5-year survival rate among living donors is 94 percent compared to 95 percent for en-bloc. And the 10-year survival rate for kidney transplants from adult donors averages 57 percent, yet it’s 75 percent for pediatric en-bloc. 

The donated en-bloc kidneys will grow roughly 60 percent inside the transplant recipient within only six weeks. “The nephrons will grow either through hypertrophy or hyperplasia, and will continue to grow with the patient,” says Wellen. 

The transplant surgery itself is more complicated than a traditional kidney transplant and takes longer, which is why en-bloc transplants are usually performed only at the larger transplant hospitals. The risks involved include those of any kidney transplant, but the en-bloc kidneys have a 5 to 10 percent chance of twisting, which results in removal and re-transplantation. The window for this complication is within 30 days of transplant, after which time, patients are considered safe and can continue on immunosuppressant medications. 

“With half a million people on dialysis, it’s essential to expand our transplant program and consider all surgical options,” says Wellen.
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