Introduction: Kidney transplantation represents the most effective treatment for pediatric patients with end-stage renal disease (ESRD), as it significantly enhances both survival rates and quality of life compared to dialysis. Nevertheless, the procedure presents distinct challenges, particularly for younger and smaller children.
Historically, studies have suggested that children weighing <15 kg may face increased perioperative risks, challenges in donor-recipient size matching, and a greater likelihood of complications compared to children > 15 kg. In this study, we aimed to rigorously evaluate the immediate and long-term outcomes of kidney transplantation in high-risk pediatric cohort weighing < 12 kg by comparing them with recipients weighing >12 kg.
Patients and Methods: In this study, we retrospectively analyzed the data of 210 pediatric kidney transplant recipients (pKTR) over a 16-year period to compare the outcomes between those weighing ≤12 kg (n=45) and >12 kg (n=165) at the time of transplantation. Baseline characteristics were compared between the two groups. Kaplan-Meier survival analysis was used to assess graft and patients survival stratified by donor type (living vs. deceased). Estimated glomerular filtration rates (eGFR) were compared at 1, 3, and 5 years and at the last follow-up.
The graft survival rates were similar between the groups at 1, 3, 5, and 10 years post-transplantation (P=0.4771). Stratified analysis according to donor type showed no significant differences in graft survival. eGFR was comparable between the groups at all time points. Subgroup analysis of recipients weighing ≤10 kg (n=21) vs. >10 kg (n=189) also demonstrated no significant differences in graft survival (P=0.717) or other outcomes. Patient survival at 10 years was excellent in both the ≤12 kg (93.5%) and >12 kg (95.3%) groups (P =0.3990). These findings suggest that kidney transplantation in children < 12 kg can achieve excellent outcomes comparable to those in > 12 kg , challenging previous assumptions about the increased risks in this population.


Conclusion: The findings challenge the conventional belief of increased risk in smaller pediatric patients, highlighting that kidney transplantation, when performed in centers with substantial experience and rigorous protocols, can achieve outcomes in small children that are comparable to those in larger pediatric recipients.