Paediatric kidney transplants from donors aged 1 year and under: an analysis of The Australian and New Zealand Dialysis And Transplant Registry (ANZDATA) From 1963 To 2018.

INTRODUCTION Kidneys from very small donors have the potential to significantly expand the donor pool. We describe the collective experience of transplantation using kidneys from donors aged ≤1year in Australian and New Zealand. PATIENTS AND METHODS The ANZDATA registry was analysed on all deceased donor kidney transplants from donors aged ≤1year. We compared recipient characteristics and outcomesbetween 1963 to 1999 and 2000 to 2018. RESULTS From 1963-1999, 16 transplants were performed (9(56%) adults, 7(44%) children). Death-censored graft survival was 50% and 43% at 1 and 5 years, respectively. Patient survival was 90% and 87% at 1 and 5 years, respectively. From 2000-2018, 26 transplants were performed. (25(96%) adults, 1(4%) children). Mean creatinine was 73µmol/L+/-49.1 at 5 years. Death-censored graft survival was 85% at 1 and 5 years. Patient survival was 100% at 1 and 5 years. Thrombosis was the cause of graft loss in 12% of recipients in the first era from 1963-1999, and 8% of recipients in the second era from 2000-2018. CONCLUSIONS We advocate the judicious use of these small paediatric grafts from donors ≤ 1year old. Optimal selection of donor and recipients may lead to greater acceptance and success of transplantation from very young donors.