The Outcome of Transplanting Kidneys From Very Small Pediatric Deceased Donors

Background. Kidneys from very small pediatric donors (VSPDs, aged <2 y) are underutilized. Concerns regarding potentially inferior outcomes hinder the use in pediatric recipients. Methods. All pediatric kidney-only transplants from <18-year-old donors between January 2012 and May 2021 in our center were included in this study. Outcomes were compared between VSPD and normal pediatric donor (NPD, aged 2-18 y) groups, and 3-y death-censored graft survival was assessed by the multivariable Cox proportional hazard model. Results. Of all 252 enrolled patients, 149 (59.1%) received kidneys from NPDs and 103 (40.9%) from VSPDs. The 3-y graft survival rates of the NPD and VSPD groups were 91.2% and 88.6%, respectively (P = 0.385). The adjusted hazard ratio of 3-y graft loss was 1.2 (95% confidence interval, 0.6-2.5; P = 0.659) for the VSPD group compared with the NPD group. There was no significant difference in estimated glomerular filtration rate at 3 y posttransplant observed between NPD and VSPD groups (86.926.8 versus 87 +/- 27.9mL/min/1.73 m(2); P = 0.991). Patients (n = 12, 4.8%) who received kidneys from donors <5kg contributed 5 (5/39, 12.8%) with delayed graft function and the sole primary nonfunction in our cohort. Conclusions. Although attention to preventing complications is necessary, especially for kidneys from donors <5kg, kidneys from VSPDs did not appear to impart added risk for 3-y graft loss and renal function.