Objective: Kidney transplantation (KTx) is the best treatment option for renal replacement therapy in pediatric patients with end-stage renal disease (ESRD). However, especially in very small children KTx can be a challenging procedure with a higher risk of peri-operative complications and poorer outcome. The aim of this study is to to analyze the outcome of KTx recipients weighting under 15 kg, focusing on surgical  and  infectious complications.

Methods: We reviewed our retrospective database for recipients of KTx between January 2018 and April 2021 with body weight under 15 kg.

Results: In the period between 1 January 2018 and 31 March 2021, 86 paediatric KTxs were performed  at  İstinye University Liv Bahçeşehir Hospital. 32 (37,2 %)  of these 86 children had a body weight of <15  kg at the time of Ktx. Twenty-seven  of 32 children  who  had detailed follow-up  data were included in the study.  There were 13 females (48.1 %) and 14 (51,9 %) males. Mean weight of the patients was 11.69±2.16 kg and mean age was 3.60±1.59 years. Median follow-up was 9.5 (6-17) months.The most common cause of ESRD was nephrotic syndrome (26.9 %). Six  (22 %) patients were on hemodialysis where as 9 (33%) were on peritoneal dialysis treatment. In 12 (44%) patients Ktx were performed pre-emptively.  The only postoperative complication was ileus (3 patients).  Five  (18.5 %) patients had BK virus, 5 patients (18.5 %) had  CMVand  1  (3.75 %) patient had EBV infection.  Urinary tract infection was  observed in 6 (22,2%) patients and none of the patients lost the graft.

Conclusion: Our results suggest that KTx in children weighing under 15 kg is not associated with increased risk of surgical and infectious complications or early graft loss. Kidney transplantation  should be considered early to allow children to reach normal  physical, mental and social development.