Use of En Bloc Kidney Allografts for Pediatric Kidney-Alone and Multiorgan Transplant Recipients in the United States

Rachel M Engen; James D Perkins; Lyndsay A Harshman; Clare Lindner; Juhi Kumar; Dechu Puliyanda; Sharon M Bartosh; Jodi M Smith

doi:10.1111/petr.70330

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Use of En Bloc Kidney Allografts for Pediatric Kidney-Alone and Multiorgan Transplant Recipients in the United States

Journal article

Open access

Peer reviewed

Use of En Bloc Kidney Allografts for Pediatric Kidney-Alone and Multiorgan Transplant Recipients in the United States

Rachel M Engen, James D Perkins, Lyndsay A Harshman, Clare Lindner, Juhi Kumar, Dechu Puliyanda, Sharon M Bartosh and Jodi M Smith

Pediatric transplantation, Vol.30(5), e70330

05/2026

DOI: 10.1111/petr.70330

PMCID: PMC13169177

PMID: 42125944

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https://doi.org/10.1111/petr.70330View

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Abstract

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.

United States

Adolescent

Allografts

Child

Child, Preschool

Female

Graft Survival

Humans

Infant

Kidney Transplantation - methods

Male

Retrospective Studies

Treatment Outcome

Details

Title: Subtitle: Use of En Bloc Kidney Allografts for Pediatric Kidney-Alone and Multiorgan Transplant Recipients in the United States
Creators: Rachel M Engen - University of Wisconsin–Madison
James D Perkins - University of Washington
Lyndsay A Harshman - University of Iowa
Clare Lindner - University of Michigan
Juhi Kumar - University of Pittsburgh
Dechu Puliyanda - Cedars-Sinai Medical Center
Sharon M Bartosh - University of Wisconsin–Madison
Jodi M Smith - University of Washington
Resource Type: Journal article
Publication Details: Pediatric transplantation, Vol.30(5), e70330
DOI: 10.1111/petr.70330
PMID: 42125944
PMCID: PMC13169177
NLM abbreviation: Pediatr Transplant
ISSN: 1399-3046
eISSN: 1399-3046
Publisher: Wiley
Language: English
Date published: 05/2026
Academic Unit: Nephrology, Dialysis and Transplantation; Stead Family Department of Pediatrics; Iowa Neuroscience Institute
Record Identifier: 9985163946702771

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