Kidneys from donors < 4 years remain underutilized because of the concerns of the recipient complications (bleeding, urine leak and graft thrombosis), and poor long-term graft outcomes. The issue of allocation of such grafts as en bloc or two separate grafts is controversial.

A retrospective database (SRTR) review of patients who received deceased donor kidney transplants between 2000 and 2012 was performed.

A total of 2535 patients received kidney transplants from the deceased donor population of interests. The majority of these organs were transplanted in an en bloc fashion (n=1613), although 36.4% of the patients received either the left kidney only (n=449), the right kidney only (n=427), or sequential transplants with two separated grafts from the same donors (n=46). 5.61% of the transplants were derived from donation after cardiac death donors. Only 4.1% (n=103) of the recipients were younger than 16 years and 64.1% of them received en bloc kidneys. The utility of en bloc transplant was seen in 82.2%, 68.1%, 54.6%, and 47.9% of the donors of age less than 1, 1 and 2, 2 and 3, and 3 and 4 years respectively. Over 50% of these kidney grafts were transplanted to patients with normal body mass index (BMI between 19 and 24), 30.1% to overweight (between 25 and 29), 12.6% to obese (over 30) and only 6.9% to underweight (below 18) recipients. The pattern of utilization and the 5 year graft outcomes were shown.

The decision of separating two kidneys in the study donor population was age dependent. The outcomes of patients received en bloc or sequential transplants of two separated kidneys from very young age donors were comparable regardless the recipients’ BMI. When two kidneys were separated and transplanted into two different recipients, patients received right kidney only had a noticeable inferior graft outcome.

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