Purpose: Cadaveric kidneys from pediatric donors represent an importan
t resource for human allotransplantation. We report 7 cases in which a
new technique was used for en bloc transplantation of pediatric cadav
er kidneys into adult recipients. Materials and Methods: Paired cadave
ric kidneys obtained from donors younger than 6 years (mean age 26 mon
ths) were transplanted en bloc into 2 children (mean age 12.5 years) a
nd 5 adults (mean age 50 years) using en bloc extraperitoneal interpos
ition of the donor aorta and vena cava into the recipient external ili
ac artery and vein. Results: All patients had excellent perfusion imme
diately following transplantation on (99m)technetium-pentetic acid per
fusion scans. Serum creatinine decreased to its nadir an average of 7
days post-transplantation in all but 1 patient. In 3 patients glomerul
ar filtration rate increased 3 to 5-fold at 3 months and 6 months afte
r transplantation. No patient had venous or arterial thrombosis postop
eratively and 2 had ureteral leaks. In 3 patients moderate to severe b
iopsy proved acute rejection episodes were successfully reversed by in
tensifying immunosuppressive treatment and recovery of allograft funct
ion was excellent following antirejection therapy. Grafts were lost du
e to chronic rejection at 10 years in 1 patient and noncompliance in 1
. Currently 5 patients are well with normal serum creatinine values at
3 months to 1 year of followup. Conclusions: En bloc transplantation
of small pediatric kidneys using a new technique averts the complicati
on of vascular thrombosis and provides adequate mass to achieve a norm
al level of renal function.