Pediatric en bloc kidney transplantation into pediatric recipients Renal transplantation has now become a safe and preferable treatment option for children with ESRD. However, the ongoing demand for renal grafts has vastly outstripped the supply leading to an ever widening gap between the number of patients on dialysis and those getting transplants. The UNOS wait list has increased dramatically with number of patients waiting for kidney transplantation increasing from 37 381 in 1997 to 70 778 in 2006 (1). Although children are given priority in receiving grafts, even more so with the recent changes in organ allocation policy, the relentless and progressive shortage in donors points to the need to expand the donor pool aggressively. To address this problem, one approach that our center has adopted has been to accept kidneys from very young donors, who in the past would not be considered as viable donors, and transplanting their kidneys ‘‘en bloc’’ into the recipient. Based on the OPTN data as of November 7, 2008, from the year 1987 to 2008, only 1.7% of the 7528 pediatric renal transplants were performed in an en bloc fashion. Because of the limited published data on pediat- ric en bloc renal transplantation, we retrospec- tively examined the clinical outcomes of the children who received en bloc kidneys from very young donors and who have been managed by very early discontinuation of steroids after renal transplantation at our center. Early experience suggested that en bloc kid- neys from small children that were transplanted into adults were prone to hyperfiltration injury, technical difficulties, and vascular complications, and thus, were associated with poor graft survival (2); hence, the reluctance to use kidneys from young donors less than five yr of age (3). However, likely as a result of growing experience Lau KK, Berg GM, Schjoneman YG, Perez RV, Butani L. Pediatric en bloc kidney transplantation into pediatric recipients. Pediatr Transplantation 2010: 14: 100–104. Ó 2009 John Wiley & Sons A/S. Abstract: As a result of the ongoing shortage in organ supply, en bloc renal transplantation from small donors has become more common for adult recipients with ESRD. However, because of concern for higher complication rates and sub-optimal outcomes, it is not being performed in every center, and data describing its use in pediatric recipients are even more limited. We retrospectively studied three patients who have undergone en bloc renal transplantation at our center. Median age at transplantation was 16.7 yr with a median follow-up of 1.2 yr. Donor age ranged from nine to 49 months with weight ranging from 10 to 22 kg. There were no post-operative thrombotic complications. All grafts showed increased renal size at follow-up by ultrasound. There was no clinical or histological rejection at last follow-up. To the best of our knowledge, this is the first report on the outcomes of en bloc kidney transplantation from pediatric donors into pediatric recipients. Based on our experience, albeit very limited, we feel that en bloc renal trans- plantation from young donors is an acceptable and safe procedure with low complication rates in pediatric recipients and should be given consideration to minimize wait times on the wait list and to improve quality of life. Keith K. Lau 1 , Gerre M. Berg 1 , Yolanda G. Schjoneman 1 , Richard V. Perez 2 and Lavjay Butani 1 1 Department of Pediatrics, 2 Department of Surgery, University of California, Davis, CA, USA Key words: pediatrics – en block – kidney transplantation Keith K. Lau, Department of Pediatrics, University of California, Davis, 2516 Stockton Blvd., Sacramento, CA 95817, USA Tel.: +1 916 734 8118 Fax: +1 916 734 0629 E-mail: keith.lau@ucdmc.ucdavis.edu Accepted for publication 25 November 2008 Abbreviatons: CIT, cold ischemia times; CMV, cytomega- lovirus; EBV, Epstein Barr virus; ESRD, end stage renal disease; GFR, glomerular filtration rate; IVC, inferior vena cava; MMF, mycophenolate mofetil; NAPRTCS, North American Pediatric Renal Trial Cooperative Study; NCEP, National Cholesterol Education Program; OPTN, Organ Procurement and Transplantation Network; SMX, sulfa- methoxazole; TMP, trimethoprim; UNOS, United Network for Organ Sharing; WBC, white blood cell. Pediatr Transplantation 2010: 14: 100–104 Ó 2009 John Wiley & Sons A/S. Pediatric Transplantation DOI: 10.1111/j.1399-3046.2009.01137.x 100