*Purpose: To explore the feasibility of en bloc kidney transplantation from infant donors less than 5kg into adult recipients.

*Methods: A retrospective analysis was conducted of 21 recipients of en bloc kidney transplant from infant donors less than 5kg between October 2015 and October 2018 in our center. Implantations were performed (Fig. 1) after careful preparations of the paired grafts (Fig. 2). Demographic characteristics of donors and recipients, graft and patient outcomes, and complications were analyzed with a follow up of 3-34 months (median 12 months).

*Results: Among 21 infant donors, the age ranged from 4 to 114 days with body weight ranging from 1.3kg to 4.9kg. Recipients’ age ranged from 16 to 47 years with body weight ranging from 38kg to 60kg. 3 paired renal grafts lose function due to arterial embolism, 2 pairs had venous thrombosis, which mainly happened in the first 10 days after transplant. The other 16 patients including 1 case of unilateral graft lost had satisfactory serum creatinine, normal estimated glomerular filtration and hemoglobin. During the follow up, the graft and patient survival rate were 76.2% and 100% respectively. Among the 11 cases with follow up more than 1 year, all have microscopic hematuria, but only one has proteinuria.

*Conclusions: Our results show that en bloc kidney transplant from infant donors less than 5kg into adult recipient can have promising outcomes. And this will be an important breakthrough for expanding the kidney pool. Improving surgical techniques and careful postoperative care make it possible for using donors with very low body weight, however information including long term outcome should be needed in the future.

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