Introduction: Despite the widespread uptake of transplantation of kidneys from DCD donors, allocating such organs to paediatric recipients remains controversial; with no large case series available to inform decision making. We present our experience of paediatric kidney transplant recipients of DCD organs.

Methods: 10 paediatric kidney transplants recipients (from DCD donors) affiliated to two hospitals were retrospectively studied. Data was collected on recipient and donor demographics, transplant type (enbloc v single kidney), biopsy results, renal function and complications.

Results: Median recipient age was 7.5 years (3.5 – 15yrs) and median donor age was 13 years (1 – 47yrs). Median follow up was 24 months (1- 72 months). 7/10 patients were dialysis dependent for 1 year or more prior to transplantation; 2/10 were pre emptive and 1 patient had vascular access issues. Donor kidneys from patients under 2yrs (n=2) were implanted as en bloc double, otherwise single kidneys were implanted (n=8). There were five cases of delayed graft function and 1 case of primary non function. The remaining 9 transplants continue to function at last follow up. Median calculated GFR (Schwartz method) at 3 months and 24 months was similar (54mls/min/1.73m2 v 57 mls/min/1.73m2, p=0.87). Time 0 biopsy performed in 5/10 patients revealed minimal cortical changes and normal glomeruli. Complications included ureteric reimplantation (n=1), surgical re-exploration for bleeding (n=2) and non-critical transplant renal artery stenosis (n=1). There were 6 episodes of (successfully treated) immune rejection in 3 patients.

Discussion: Utilising kidneys from DCD donors in children can be beneficial in specific circumstances and is associated with good outcomes. The data presented suggests that including selected paediatric recipients in any future national DCD kidney allocation scheme may be justified.

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