Objective To compare the efficacy of single kidney transplantation(KT)from pediatric donors between donors aged＜2 and 2-18 years.Methods Between August 2016 and May 2023,127 single pediatric kidney transplantations involving pediatric donors were conducted.They were assigned into two subgroups based upon age of small pediatric donors(n=22,SPD,donors aged＜2 years)and normal pediatric donors(n=105,NPD,donors aged 2-18 years).A retrospective analysis was performed to compare recipient/donor baseline characteristics,postoperative complications and recipient/graft survival rates between two groups.Results Significant inter-group differences existed in donor age[11.0(10.0,15.0)vs 121.0(74.0,166.0)month],donor weight[8.3(8.0,9.4)vs 30.0(20.0,50.0)kg]and graft-to-recipient weight ratio[0.3(0.2,0.5)vs 1.0(0.6,1.5)](P＜0.001).Conversely,no significant inter-group differences existed in donor gender/type,warm/cold ischemic time,human leukocyte antigen mismatch number,estimated glomerular filtration rate,recipient gender/age/weight,number of transplants,preoperative dialysis,preoperative induction therapy,panel-reactive antibody or primary disease(P＞0.05).The incidence of vascular thrombosis was 9.1％(2/22)and 0 in SPD and NPD groups with statistically significant differences(P=0.029);the incidence of post-transplant hemorrhage was 13.6％(3/22)and 1.9％(2/105)with statistically significant difference(P=0.036).However,no statistically significant inter-group differences existed in recurrent renopathy,delayed graft function or 1-year cumulative incidence of acute rejection(P＞0.05).Six recipients(27.3％)in SPD group lost allografts due to recurrent or primary nonfunction(n=1),vascular thrombosis(n=2),post-transplant hemorrhage(n=2)and thrombotic microangiopathy(n=1).In comparison,three recipients(2.9％)in NPD group lost allografts due to rejection(n=2)and infectious rupture of transplanted renal artery(n=1).Three-year recipient survival rates were 100％and 99.0％in SPD and NPD groups with no statistically significant differences(P=0.600).And 3-year death-censored graft survival was significantly lower in SPD group than that in NPD groups(77.3％vs 91.5％)(P＜0.001,HR=8.3,95％CI:2.0-34.2).Conclusions Early postoperative vascular complications after single pediatric KT from pediatric donors aged under 2 years are frequent and predispose to graft loss.
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