Outcomes and learning curve of single-kidney transplantation from small pediatric donors in children: a retrospective cohort study with meta-analysis.

OBJECTIVE: To evaluate clinical outcomes of single-kidney transplantation from small pediatric donors (weight ≤ 15 kg or age ≤ 3 years). METHODS: This retrospective cohort study included 77 children transplanted at our center (Oct 2022-May 2026): 26 small-donor vs. 51 large-donor recipients. CUSUM learning curve analysis and meta-analysis of seven studies (527 patients) were performed. RESULTS: In the cohort, small-donor group had lower 1-year graft survival (73.1% vs. 100%, P < 0.001) and higher acute rejection (19.2% vs. 2.0%, P = 0.026), while thrombosis, DGF, and patient survival were similar. EGFR at 1 year was comparable between groups. CUSUM showed an inflection at Case 16 in the small-donor group, with operative time decreasing from 187.6 to 146.3 min. Meta-analysis yielded 1-year patient survival of 98%, graft survival 91%, and pooled thrombosis, DGF, and acute rejection rates of 5%, 13%, and 10%, respectively. CONCLUSIONS: Early graft loss risk in small-donor single-kidney transplantation declines after the learning phase, with acceptable short-term outcomes and high organ utilization. This approach appears feasible in experienced centers, though long-term efficacy requires prospective validation.