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Comparative analysis finds trends in en bloc and single kidney transplants among pediatric recipients, suggesting implications for outcomes.
BACKGROUND: En bloc kidney transplantation is controversial, but recent adult studies increasingly show outcomes that are similar to or superior to those of high-quality single kidney transplants. The use of en bloc allografts in children in the modern allocation era has not been reported. METHODS: We compared SRTR data on en bloc kidney transplants in pediatric recipients 2000-2014 and 2015-2024 to better understand trends in utilization and outcomes in pediatric recipients. RESULTS: There were 176 en bloc transplants in pediatric recipients, 138 in the 2000-2014 era, and 38 in the 2015-2024 era. 43.7% of en bloc transplants were part of a multiorgan transplant. Between 2013 and 2024, there was a decreasing use of en bloc allografts overall and specifically for kidney-alone recipients. En bloc kidney-alone transplants had decreased graft survival compared with single kidney transplants in the first year posttransplant, but similar outcomes thereafter. En bloc kidney-multiorgan transplants had superior graft survival after 1 year posttransplant compared with single kidney-alone transplants. CONCLUSION: Utilization of en bloc kidneys has declined in pediatric recipients but can have good outcomes in a select population. More information is needed to understand whether and how best to use en bloc kidney transplantation for adolescents with reduced access to transplant.
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Engen et al. (2026) studied this question.
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