*Purpose: Kidney paired donation (KPD) provides the opportunity for ABO-mismatched or HLA-incompatible pairs to receive a living donor kidney transplant. The superior graft survival among living donor kidney recipients is of particular importance in the pediatric population, who will likely require multiple transplants in their lifetime. KPD represents a potential strategy to increase living donation in this population. While the use of KPD in adults in increasingly common, its use in the pediatric population is not well described.

*Methods: We used SRTR data to describe the population of pediatric living donor transplant recipients, 2014-2019, by KPD status. Chi-squared tests for difference by KPD status were performed. We compared the proportion of pediatric and adult KPD recipients during the same interval.

*Results: The number of pediatric recipients of KPD kidneys is small but increased from 8 (3.3% of living donor recipients) in 2014 to 18 (7.5%) in 2019, with a peak of 25 (9.1%) in 2018. KPD use is higher in adults and has been growing steadily since 2014 (Figure 1). Characteristics more common to pediatric KPD recipients than to other pediatric living donor recipients were Black race (18.0% vs. 8.3%), previous transplant (15.7% vs. 6.5%), panel reactive antibodies >20% (33.7% vs. 13.8%), and donor <10 years older than the recipient (6.7% vs. 2.7%) (Table 1).

*Conclusions: Participation in KPD programs presents logistical and financial challenges for pediatric kidney programs, but an increasing number have been performed in recent years. This program could provide increased transplant opportunities for pediatric recipients, especially for disadvantaged groups.

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