Outcomes of kidney transplantations in children weighing 15 kilograms or less: a retrospective cohort study

Summary Kidney transplantation ( KT ) is often delayed in small children because of fear of postoperative complications. We report early‐ and long‐term outcomes in children transplanted at ≤15 kg in the two largest Belgian pediatric transplant centers. Outcomes before (period 1) and since the introduction of basiliximab and mycophenolate‐mofetil in 2000 (period 2) were compared. Seventy‐two KT s were realized between 1978 and 2016: 38 in period 1 and 34 in period 2. Organs came from deceased donors in 48 (67%) cases. Surgical complications occurred in 25 KT s (35%) with no significant difference between the two periods. At least one acute rejection ( AR ) occurred in 24 (33%) KT s with significantly less patients experiencing AR during period 2: 53% and 12% in period 1 and, period 2 respectively ( P < 0.001). Graft survival free of AR improved significantly in period 2 compared with period 1: 97% vs. 50% at 1 year; 87% vs. 50% at 10 years post‐ KT ( P = 0.003). Graft survival tended to increase over time (period 1: 74% and 63% at 1 and 5 years; period 2: 94% and 86% at 1 and 5 years; P = 0.07), as well as patient survival. Kidney transplantation in children ≤15 kg remains a challenging procedure with 35% of surgical complications. However, outcomes improved and are nowadays excellent in terms of prevention of AR , patient and graft survival.