To assess outcomes and surgical techniques of kidney and en-bloc kidney transplantations (EBKT) from neonatal and pediatric donors to adult recipients at a single center, including a graft from a 9-day-old donor.

A retrospective single-center analysis was conducted of all kidney transplants from donors younger than 3 years to adult recipients over the last 10 years. Donor and recipient characteristics, surgical techniques, graft function, and complications were assessed. For a 9-day-old donor graft, volume was measured using ultrasound and MRI. Renal scintigraphy was used to evaluate split renal function.

Seven kidneys from donors younger than 3 years were transplanted into adult recipients. Six of these 7 transplantations were performed as EBKT, and all recipients developed sufficient renal function with eGFR ranging from 64.34 to 113.51 mL/min/1.73 m ² at a median follow-up of 427 days.

The EBKT from a 9-day-old donor showed delayed graft function, requiring a single dialysis session in the first week. Electrolyte imbalances were managed with diuretics. Kidney volume increased from 24.59 mL (day 8) to 69.61 mL (day 121), accompanied by an eGFR of 73.01 mL/min/1.73 m ² . Scintigraphy showed a 57%/43% functional split, and MRI revealed grade II vesicoureteral reflux.

This center analysis supports the feasibility of using neonatal and pediatric kidneys—single or EBKT—for adult transplantation, with strong functional recovery despite early surgical challenges.