The Evolving Experience and Outcomes of Pediatric Kidney Transplant in Abu Dhabi, UAE (2010-2024).

Background: Kidney transplant is acknowledged as the treatment of choice for end-stage renal disease (ESRD). This study reports on the outcome of pediatric renal transplant at a tertiary hospital in Abu Dhabi. Methods: It is a retrospective study of all pediatric renal transplants performed at a single designated pediatric center between February 2010 and February 2024, including children aged 1-16 years. Results: Sixty-nine (44% female) pediatric renal transplants were performed, 36 from living-related donors and 33 from deceased donors. The mean age at transplant and last follow-up were 9.8 ± 3.6 years and 13.8 ± 4.7 years, respectively. ESRD etiologies included congenital anomalies of the kidney and urinary tract (39%), nephronophthisis (19%), glomerulonephritis (13%), and other causes (29%). Thirteen (19%) children underwent a preemptive transplant, whereas 56 (81%) were on dialysis at transplant. Thirty-one (45%) children had graft rejection: 16 (23%) in the first year, 9 (13%) in years 2-5, and 6 (9%) thereafter. Donor-specific antibodies (DSAs) were detected in 19 (28%) children; 17 (25%) of those had graft rejection with anti-DR or anti-DQ alloantibodies. Fourteen children had DSA-negative graft rejection. Of those, eight had cell-mediated rejection, and six had mixed rejection. Predictors of rejection were positive DSA ( Conclusion: The outcome of pediatric kidney transplants in Abu Dhabi over 14 years shows patient and graft survival comparable to published data. Acute graft rejection remains a major challenge with the presence of DSA and biallelic HLA-DR mismatch as independent predictors for rejection. Optimizing donor selection, immunosuppression, and closer surveillance are vital.