Background: Pediatric cadaveric kidneys from small donors are offered as en bloc kidneys for transplantation. Recent data supports using these en bloc kidneys in pediatric patients with acceptable results. Kidney transplantation from pediatric donors increases the number of available organs for transplantation if used en bloc; however, there are some pediatric recipients who would benefit from transplant in whom adult sized kidneys or en bloc kidneys are contra-indicated due to cardiac, or respiratory issues. We present our experience using single pediatric kidneys from split en bloc kidneys in size matched recipients.

Methods: We reviewed 5 patients in whom single pediatric kidneys from donors less than19 kgs were used for transplantation from 2009 -2012. We reviewed the serum creatinine, estimated glomerular filtration rate (eGFR) using bedside Schwartz GFR calculator, routine transplant kidney ultrasound for size stability or growth

Results: We identified 5 pediatric patients who received single pediatric kidneys. Recipients for single kidneys were selected programmatically based on the following critieria: cardiomyopathy with ejection fraction < 25% and Dennys-Drash syndrome, Jeune syndrome with respiratory compromise, and small size with concern for respiratory compromise. One patient received a liver and kidney transplant from a size matched donor. We had a mean follow up of 14.9 months (range 5-34). All patients demonstrated an increase in eGFR (Table 1) with only 1 patient with delayed graft function.

No grafts were lost over the time of followup and no surgical complications were noted. Size in single kidneys increased by 1-2 cm in length as measure by ultrasound over the follow up period.

Conclusions: Use of small split en blocs can be used with acceptable results in a small sub group of children with specific disease states with acceptable outcomes. Both size and GFR increase over time. By splitting en bloc kidneys, organ availability can be increased in specific recipients.

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