Kidney transplantation in children weighing 15 kg or less is challenging but associated with good outcome

Summary Objective Pediatric kidney transplantation (KT) in small children is assumed to be related to potential surgical complications that may cause severe morbidity and graft loss. The aim of our study was to analyze the outcome of KT recipients weighing ≤ 15 kg, focusing on surgical complications, associated morbidity and mortality, as well as allograft loss. Methods We reviewed our retrospective institutional database for recipients of KT between January 2000 and December 2014 with body weight ≤ 15 kg. Results Forty-four children weighing ≤ 15 kg, out of a total of 164 children (26.8%), received a deceased donor KT at our center during the study period. Mean weight was 10.10 ± 2.9 kg (3–15 kg), and weight was ≤ 10 kg in 23 patients (52.3%). The allograft was implanted intraperitoneally in two cases (4.5%) and extraperitoneally in the remaining 42 (95.5%). Two patients received a simultaneous double liver–kidney transplant. Postoperative complications appeared in 10 patients (22.7%) and eight required reintervention. Five allografts (11.4%) were lost secondary to surgical complications. No statistically significant differences in surgical complications were observed when compared with patients weighing > 15 kg. Actuarial graft survival was 81% and 73% at 1 and 5 years, respectively. No significant differences in graft survival were observed compared with patients > 15 kg. Mean follow-up was 84.95 ± 50 months (1–190 months). Conclusions Our results demonstrate that KT in children weighing ≤ 15 kg is challenging but not associated with increased risk of surgical complications or early graft loss.