Single Versus En Bloc Kidney Transplantation From Donors ≤ 5 Years of Age in the United States: An Analysis of the Scientific Registry of Transplant Recipients From 1987 to 2023

ABSTRACT Background This widening disparity between demand and supply necessitates innovative approaches to augment the pool of potential donors. Utilizing en bloc kidneys (EBKT) from newborns and small pediatric donors represents one promising strategy. Despite their smaller size, these kidneys have demonstrated considerable success in transplantation. Methods and Materials A retrospective cohort analysis of the SRTR database was done for kidney transplants that were performed en bloc or single from donors younger than 5 years old in the United States from 1987 to 2023. Results After considering the inclusions and exclusion criteria, a total of 7355 kidney transplantation cases were included in the final study analysis, in which 4546 cases have received en bloc allografts and 2809 cases have had single kidney transplantation (SKT). The data analysis showed the higher 5‐year patient survival rate in the EBKT group in comparison to the SKT group (87% vs. 81%, p value < 0.001); also, the 5‐year allograft survival rate in the EBKT group is significantly higher than the SKT group (85% vs. 77%, p value < 0.001). As expected, delayed graft function (DGF) has increased the chance of graft failure in both EBKT and SKT groups (HR: 4.86 [3.69–6.39] vs. HR: 2.13 [1.56–2.89], respectively); also, the patient survival rate was lower when the patients had DGF in both EBKT and SKT groups (HR: 2.29 [1.50–3.48] vs. HR: 1.71 [1.12–2.59], respectively). Conclusion Our study supports the use of EBKT as a promising option for kidney transplantation from pediatric donors under 5 years old. The higher patient and graft survival rates observed in the EBKT group highlight the potential benefits of this approach in expanding the donor pool and improving transplantation outcomes.