*Purpose: The infectious risks of immunosuppression following pediatric kidney transplant are well described but little is known about the impact of infections on patients with advanced chronic kidney disease awaiting kidney transplant. We hypothesized that infections were a common cause of delays in anticipated living donor transplants (LDKT) and accounted for increased periods of inactivation from the UNOS deceased donor (DDKT) waiting list.

*Methods: We conducted a retrospective review of all pediatric kidney transplants completed at our institution between July 2015 and November 2020 to assess for infections as a cause of LDKT re-scheduling and / or inactivations on the UNOS waitlist. Patients that underwent multiple kidney transplants were included if both transplants were conducted at our center within the given time frame.

*Results: A total of 86 pediatric kidney transplants (40% living donor) were performed at our institution (average age at transplant 11 years, range 1-20). Of the 4 (11%) LDKT that were delayed after an initial surgical date had been scheduled, two were due to active infections noted at the time of admission for transplant, one due to COVID-19 restrictions at the hospital, and one was not documented. In the 52 DDKT, 17 patients had 24 periods of inactivation from the UNOS waiting list that ranged in duration from 6 – 156 days (mean 27 days). Eleven (46%) of inactivation periods were due to infectious illnesses: 1 urinary tract infection, 1 disseminated varicella, 1 line infection, 3 peritonitis, 5 respiratory infections (two complicated with concurrent bacterial infections).

*Conclusions: Infections during the pre-transplant period resulted in multiple delays of both living and deceased donor pediatric kidney transplants. Multicenter studies should be performed to assess the risk of infectious complications for children on the kidney transplant waiting list in order to evaluate risk mitigation strategies.

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