Introduction: Although Pediatric kidney transplantation poses unique anatomical, immunological, and psychological challenges, it offers excellent long-term survival and quality of life benefits. However, comparative data from resource-limited countries remain sparse. This study compares perioperative characteristics and transplant outcomes between pediatric and adult recipients undergoing living donor kidney transplantation (LDKT) at a high-volume transplant center.
Methods: This retrospective comparative study involved 134 pediatric recipients (≤18 years) and 2,114 adult living donor kidney transplant recipients (KTRs) who underwent transplantation between September 2008 and December 2022. Clinical, surgical, and follow-up data were obtained from prospectively maintained electronic departmental databases. Recipients were compared across demographic, intraoperative, and postoperative parameters. Primary outcomes included graft function, allograft rejection, graft loss, and patient survival, with a mean follow-up of 5 years. Missing data were handled using pairwise deletion during analysis, and no imputation was performed.
Results:  Pediatric recipients exhibited significantly better early graft function, with improved eGFR at discharge (p<0.001), and at 1 month (p<0.001), 3 months (p<0.001), and 1 year (p<0.001). Immediate graft function was more frequent in pediatric recipients (p = 0.001), with shorter hospital stays (p = 0.011). Pediatric recipients also had significantly lower HLA mismatches (p<0.001) and a higher proportion of related donors (p<0.001). Despite significantly lower ATG induction (18.7%) in pediatric recipients, rates of biopsy-proven acute rejection (23.5% vs. 22.3%), graft loss (7.5% vs. 6.5%), and mortality (3.7% vs. 7.4%) were statistically comparable to adult LDKT.
Conclusion: Consistent with the international literature, pediatric kidney transplants (KTRs) at our center achieved optimal graft function and comparable survival outcomes to those of adult KTRs despite low ATG induction rates, which reinforces the viability of pediatric transplantation in low-resource settings. Favorable donor-recipient profiles, surgical experience, and multidisciplinary care likely contributed to these outcomes. Emphasis on early referral and adolescent-focused support may further enhance long-term success.