Small donors, a learning curve, and the price paid by the first fifteen children

The edition in brief

Four findings for the nephrology desk, plus one regulatory action. A single centre transplanted 77 children between October 2022 and May 2026, 26 receiving single kidneys from donors weighing 15 kg or less or aged 3 years or under, and 51 from larger donors. One-year graft survival was 73.1% against 100% and acute rejection 19.2% against 2.0%; thrombosis, delayed graft function, patient survival and one-year eGFR were similar. Cumulative sum analysis found an inflection at the sixteenth small-donor case, with operative time falling from 187.6 to 146.3 minutes. A meta-analysis of seven studies and 527 patients gave pooled one-year patient survival of 98% and graft survival of 91%. A genome-wide association meta-analysis of creatinine clearance in 58,976 people of European ancestry identified 16 independent loci, two of them not previously reported for kidney function, plus two female-specific loci near GPC6 and IGF1R. Creatinine clearance is independent of muscle mass, which is what eGFRcrea is not. A meta-analysis of four studies and 787 patients found omitting routine parenchymal renorrhaphy during off-clamp robot-assisted partial nephrectomy did not change Trifecta achievement overall (risk ratio 1.17, 95% CI 0.97-1.41, I-squared 86.5%), with a smaller perioperative eGFR fall but no difference at three months. PRoMPT BOLUS randomised 9,041 children with septic shock across 47 emergency departments to balanced fluid or 0.9% saline. Major adverse kidney events at 30 days occurred in 3.4% against 3.0% (risk ratio 1.10, 95% CI 0.88-1.40). Hyperchloraemia was much less common with balanced fluid, 31.4% against 49.0%. The FDA approved a supplement to the empagliflozin-linagliptin-metformin application on 11 August.