*Purpose: On September 5^th, 2019, UNOS implemented an important policy change in the allocation of kidneys from small pediatric donors. In trying to balance achieving optimal outcomes with the principals of efficiency and utilization, the policy stipulated that donors weighing less than 18 kg should be offered en-bloc. However, there have been limited studies on the outcomes of kidneys from such small donors when they are transplanted individually into two recipients, rather than en-bloc. The long-standing practice at our institution has been to transplant kidneys individually from any donor weighing over 5 kg, and kidneys measuring greater than 5 cm.

*Methods: We retrospectively reviewed our series of 81 recipients of single kidneys from pediatric donors weighing less than 18 kg, from 2006-2018. We compared these results versus their expected outcomes based on their KDPI.

*Results: The key characteristics of the group are summarized in Table 1. There were 4 cases (4.6%) of primary non-function, all of which were with donors weighing less than 10 kg. There were 8 deaths, with a median follow-up of 4.9 years. As shown in Figure 1, the long-term death-censored graft survival rates are good and superior to that predicted by the KDPI.

*Conclusions: Single pediatric kidneys from donors weighing less than 18 kg can be transplanted into standard adult recipients with good long-term outcomes. Transplanting single kidneys from pediatric donors weighing less than 10 kg into standard adult recipients is associated with an increased risk of primary non-function; however, the overall rate is low.

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