*Purpose: Due to concerns of donor-specific alloimmunization during pregnancy, some have suggested avoiding living donor kidney transplants (LDKT) from offspring to biological mothers. Published analyses of UNOS data have yielded conflicting results, but there is limited data from single centers, which can provide more granular baseline information to perform adjusted analyses. In this study, we analyzed outcomes of offspring transplants to mothers.

*Methods: All LDKT between 2013 and 2017 from our transplant program were analyzed. Offspring to mother transplants were defined as cases and two groups of controls were selected in a 1:1:1 ratio. Control 1 was offspring to biological fathers, matched for recipients age and DR mismatch and control 2 was all other remaining living donors, matched for recipients age, DR mismatch and HLA mismatch (out of 6).

*Results: There were a total of 511 LDKT during the study period, of which 19 were cases, 19 (out of 43 fathers receiving offspring kidneys) matched LDKT were selected as control 1, and of the remaining 449, 19 matched LDKT were selected as control 2. Most of the recipients’ baseline characteristics were similar between the groups. Not surprisingly, donors were significantly younger in cases (37.6 yrs) and control 1 (36.2 yrs) compared to control 2 (51.5 years) p < 0.001. There was no difference in the percentage of LDKT with pre-transplant DSA, mean HLA mismatch out of 6 or 12, or DR or DQ mismatch between the groups. Mean post-transplant follow-up was no different between groups. A total of 7 LDKT developed denovo DSA and 9 had acute rejection, with no significant difference between the groups. 1-year graft and patient survival was 100% in all three groups. There were a total of 6 graft failures at last follow up, 1 among the cases, 1 in the control 1, and 4 in the control 2 ( p=0.2). The total number of patients with graft failure or eGFR <45 were similar between the groups: case (4), control 1 (3), Control 2 (8) (p=0.15). This was further confirmed by the K-M survival analysis curve (Figure 1). Similar results were obtained using as the composite endpoint graft failure or rejection or eGFR <45.

*Conclusions: Although our data was limited by a small sample size, we present detailed information about offspring kidney transplants and do not find evidence of adverse outcomes in offspring to mother kidney transplantation. Because of potential emotional motivations for offspring to donate directly to their mothers, we do not believe that such transplants should be discouraged, especially in the absence of detectable DSA.

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