*Purpose: We previously reported that children with end-stage renal disease had less chance to access to kidney transplantation from deceased donors in China. The number of pediatric donors significantly increased since implementation of the new national deceased organ donation program. Instead of en bloc kidney transplantation, many small pediatric kidneys were transplanted to children in a single-transplant manner to shorten their waiting-list time. Herein we reported the outcome of 56 single kidney transplantations (SKTs) from small pediatric donors weighing less than 10 Kg.

*Methods: All SKTs in children at two centers from May 2014 to April 2018 were retrospectively analyzed. Estimated glomerular filtration rate (eGFR) calculated by Schwartz formula used for renal function assessment and graft growth was measured by ultrasound examination.

*Results: Of 56 SKTs included, 13 were from donor weight ≤5 Kg and 43 were from 5-10 Kg. The median age of donors and recipients was 8.9 months and 9 years, and the median body weight was 7.8 Kg and 22 Kg, respectively. The 1-year patient and death-censored graft survival was 94.3% and 91.1%, and the 2-year was 92.1% and 85.5%, respectively. The causes of graft loss were early vascular thrombosis (n=4), primary nonfunction (n=1), chronic rejection (n=2) and recurrent IgA nephropathy (n=1). The eGFR dramatically increased within the first month after transplantation from 36.7 ml/min/1.73m² to 51.0 ml/min/1.73m² (p<0.001), and still presented increasing tendency even till 24 months post-transplant (median eGFR, 86.8 ml/min/1.73m²). The renal grafts gained an adaptive growth in pediatric recipients, whose median length grew from 6.7 cm to 10.2 cm 24 months post-transplant.

*Conclusions: Dialysis treatment is less than satisfactory for uremic children in China, and many of them died of infection or heart failure during dialysis. Utilization of small pediatric donors weighing less than 10 Kg is a feasible option to shorten their waiting-list time and provide them with a second life. It’s noteworthy that graft survival is unsatisfactory mainly because more complications happened in donors weighing less than 5 Kg. Hence SKTs from pediatric donors to pediatric recipients should be performed with appropriate donor weight and donor weight above 5 Kg may be a preferred choice. In fact, since November 2018, a new program has been implemented that uremic children are given priority in allocation of pediatric donors in China. Guided by new allocation policy, more uremic children in China will gain access to kidney transplantation with our strategy.

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