Outcomes of Single Pediatric Kidney Grafts: An Experienced Single-center Retrospective Study

Kidney transplantation (KTx) is superior to dialysis but is limited by organ shortages. Kidneys from pediatric donors, whether single or en bloc, have excellent outcomes but are underutilized, with little consensus on splitting pediatric en bloc grafts.

A single-center retrospective review of all deceased donor KTx using single kidneys from pediatric donors weighing ≤20 kg between 2005 and 2023 was performed. Recipients were compared based on donor weight: <15 and ≥15 kg. Data are presented as medians (interquartile range) and numbers (percentages).

Seventy-two recipients were identified, with 36 (50%) males and a median age of 48.3 y at KTx. Donor weight ranged between 7 and 20 kg, with 24 patients receiving a single graft from donors <15 kg and 48 having received a single graft from donors ≥15 kg. Kidney length measured 6-9 cm, with those in the <15 kg group having significantly shorter kidney length relative to those in the ≥15 kg group (7 versus 7.5 cm; P = 0.05). Both Kidney Donor Profile Index (60 versus 50; P = 0.002) and use of hypothermic machine perfusion (96 versus 63%; P = 0.002) were significantly higher in the <15 kg group. Primary nonfunction was significantly higher in the <15 kg group (12.5% versus 0.0%; P = 0.03). One graft was lost because of thrombosis in the ≥15 kg group. There was no difference in graft survival between weight groups, with 5-y graft survival approaching 91% for the entire cohort.

Our center's experience demonstrates that single pediatric kidney grafts from donors carry excellent long-term outcomes, especially in donors >15 kg. However, single grafts from donors <15 kg carried a higher risk of primary nonfunction and should be approached with particular caution regarding donor quality and cold ischemia time.