Utilization of Pediatric En Bloc Kidneys from Donation After Cardio-Circulatory Determination of Death: 15 Years of Experience.

INTRODUCTION: Despite the efforts by the Organ Procurement and Transplantation Network (OPTN) to improve utilization of organs from very small pediatric donors, en bloc kidney grafts are still disproportionately discarded. Although associated with increased technical complications, en bloc kidney transplants achieve excellent graft function and longevity. We present our single-center experience with en bloc kidney transplants in adult recipients and compare outcomes between donation after cardio-circulatory death (DCD) and brain death/death by neurologic criteria (BD/DNC) organs. METHODS: Retrospective analysis was completed of all en bloc kidney transplants performed at a single-center academic transplant program, between 2008 and 2023. Two groups were defined according to the type of pediatric donor: DCD or BD/DNC. Demographic data, clinical variables, postoperative complications, and survival outcomes were compared between both groups. RESULTS: Forty-two adult recipients received pediatric en bloc kidneys, 11 of these from DCD donors. The DGF rate was higher for DCD en bloc kidneys (27% vs. 16% for BD/DNC); however, this difference was not statistically significant. Nearly one third of patients required re-operation during the index transplant admission (28.6%). Four grafts were lost secondary to thrombosis -4(10%). Urological complications occurred in 9.5% of cases. Nevertheless, technical complications were not statistically different between both groups. Patient and graft survival rates were excellent in both groups. All recipients sustained serum creatinine values below 1 mg/dL beyond the first year post-transplant. CONCLUSION: Although en bloc kidney transplantation of pediatric en bloc kidneys can be associated with greater rates of technical complications, these grafts can lead to excellent graft function and patient longevity. Diligent patient selection and an experienced surgical team are paramount to optimize the outcomes of en bloc kidney transplants.