Introduction: The optimal use of kidneys from pediatric deceased donors remains undetermined in China. Choice of single (SK) versus en bloc (EBK) transplantation was empirically determined in different transplant centers due to lack of standard criteria. This study was designed to demonstrate the transplant outcome of single versus en bloc transplantation from pediatric deceased donors using registry data from Chinese Scientific Registry of Kidney Transplantation (CSRKT).

Subjects and Methods: Registry data (2010-2015) of primary Kidney transplantation from pediatric deceased donors in Chinese Scientific Registry of Kidney Transplantation (CSRKT) was retrospectively analyzed.

Results: There were 772 cases of primary single (n=703) or en bloc (n=69) Kidney transplantation from pediatric deceased donors. They were performed in 74 transplant centers. However, only 12 centers were capable of performing EBK and 34 centers capable of performing kidney transplantation from donors weighted less than 20kg. About 88.1% (680/772) of recipients were over 18 years old. About 71.0% (49/69) of en bloc transplantation was performed in adult. Univariate Cox regression showed that a significant increase in risk of graft loss was identified in EBK group compared with SK group (Hazard ratio, 2.66; 95% confidence interval, 1.41-5.00; P=0.002). There was also increased risk of graft loss in recipients with donor weight of 5-10kg compared with recipients with donor weight of ≥20kg (Hazard ratio, 4.32; 95% confidence interval, 2.00-9.37; P<0.001). Multivariate Cox regression controlling confounding variable such as donor weight and recipient age showed that a significant increase in risk of graft loss was identified in EBK group compared with SK group (Hazard ratio, 2.18; 95% confidence interval, 1.08-4.39; P=0.029). Graft loss rate of en bloc kidney transplant varied among transplant centers from 0 to 100% with a median of 8.0%. Subgroup analysis based on donor weight demonstrated that in 5-10kg subgroup only 10% of EBK recipients (1/10) lost their allograft function while 23.5% of SK recipients (8/34) had their kidney allograft loss at the end of follow up. Graft loss rate of single kidney transplant from donors weighted 5-10kg was also various among transplant centers from 0-100% with a median of 10%. No significant difference was seen in patient survival, incidence of DGF and 1-year post-transplant allograft function between EBK group and SK group.

Discussion and Conclusion: Outcome of pediatric EBK recipients was not as good as SK recipients in terms of graft survival. It could be partly explained by the various outcome in different transplant centers, to which surgical difficulties in EBK in adult and disparity of surgeons’ technical skills were attributed. Single kidney transplantation in low-weight recipients from small pediatric deceased donors (weighted 5-10kg) was a good way to expand donor pool. However, it had difficulties in identification of indication, surgical skills as well as peri-operational management. Both EBK and single kidney transplantation from small pediatric deceased donors should be performed in experienced transplant centers.