Transplantation of kidneys from very small pediatric donors is associated with a high rate of surgical complications and graft loss. We examined our series of small pediatric transplants to identify factors that contribute to perioperative complications.

Methods: All transplants from pediatric donors <20kg from 6/2007 to 11/2012 were studied. Complications were defined as thrombosis of one or both en bloc kidneys, return to surgery for any reason, surgical site infection and ureteral stenosis/leak. Univariate/multivariate analysis was performed to identify factors associated with the development of complications.

Results: 146 patients received kidneys from <20kg donors. 89% of donors were from a distant OPO, 34% were after circulatory death, 35% weighed ≤5kg and 88% of kidneys were transplanted en bloc. Patient and graft survival at 1 year were 98% and 93%, respectively. Complications occurred in 35(24%) patients as shown in Table 1. Patients with complications were lighter, received organs from younger and lighter donors with longer cold ischemia time, had more DGF and lower e-GFR post transplant. By multivariate analysis only recipient weight (p=0.029), donor weight (p=0.007), and cold ischemia time (p=0.002) were associated with complications.

Conclusion: Despite increased complications, kidneys from very small donors can be utilized with acceptable short term outcomes. Efforts to decrease complications should be focused on minimizing ischemia time and improving surgical technique/management in the smallest donors, particularly those weighing ≤5kg. Long term follow up is warranted for kidneys from this relatively untapped donor population.

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