EDITORIAL COMMENT

En bloc kidney transplantation, which refers to harvesting of both kidneys along with major blood vessels, and performing anastomoses of the allograft vena cava and aorta to the recipient vessels, has an increased risk of graft thrombosis and hyperfiltration injury. However, reports of adult recipients from very young donors show very good long-term results. Contrary to that in adults, the data on en bloc kidneys in pediatric recipients is limited. In this retrospective cohort study, the authors has compared time to allograft failure and estimated glomerular filtration rate (eGFR) in 6882 pediatric recipients of both en bloc and standard criteria deceased donors using Organ Procurement and Transplantation Network data for over a 13-year period. Besides showing a similar allograft survival to standard criteria deceased donors, en bloc kidney recipients (1.8%) also had a shorter wait list time and superior kidney function in the intermediate term supporting the use of these kidneys for pediatric recipients. The use of en bloc pediatric kidney transplants is a reasonable option for children awaiting a cadaveric kidney at transplantation centers experienced in en bloc kidney transplantation. However, longer-term outcomes, including the risk of hyperfiltration injury, need to be determined.