*Purpose: To overcome organ shortage, using en bloc renal allografts is widely accepted strategy. In this study we review the results of en bloc kidney transplantation of pediatric donors performed at a single center.

*Methods: From January 2001 to December 2017, 607 deceased donor kidney transplantations have been performed at our center. En bloc kidney transplantation was considered if donor was younger than 3 years, less than 15 kg or the size of kidney was less than 6 cm. We retrospectively reviewed the medical records of these patients. Data collected included recipient and donor demographics, postoperative complications (vascular and urologic), renal function and the growth of kidney. The size of the graft was measured using sonography and the size was indicated by maximal longitudinal length.

*Results: A total of 13 patients received en bloc kidney transplantation during study period. The mean age of donor was 1.0 years (0.4-2.5), the mean weight was 11.6 kg (8.0-13.4), and the weight of en bloc kidney graft at the time of implantation was 91.2 g (68.2-124.8). The mean age of recipients was 8 years (6.5-10.0), and all recipients except one were under 18 years old. One-year and 5-year graft survival were 100% and 92.3% (12/13), respectively. One-year and 5-year serum creatinine were 0.60 mg/dL (0.54-0.70) and 0.67 mg/dL (0.59-0.90). Eleven grafts out of 13 were functioning at last follow up (median of 9.8 years, 6.9-13.1) and the median eGFR of 11 functioning grafts was 94.2 mL/min/1.73 m2 (85.5-129.1). Because of thrombosis formation during surgery, one patient had to remove one of the en bloc kidney allografts. Since then, renal function had gradually deteriorated, and the patient underwent re-transplantation after 1.5 years. One graft failed at 5.8 year after transplantation and the main reason of failing was acute T cell mediated rejection. There were two urologic complications during the immediate postoperative period, all of which were treated by re operation. The median graft size was 7.5 cm (6.5-8.5) within 1 month and increased to 9.7 cm (8.4-10.8) after 1 year (p <0.001).

*Conclusions: En bloc kidney transplantation showed acceptable short-term and long term outcome. Transplanted kidneys showed substantial growth and maximal longitudinal diameter increased by 20.9% (14.2-33.5) after 1 year.

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