Utilization and outcomes of COVID-19 positive donors in pediatric kidney transplantation—a population-based study

Background: COVID-19 infection has been associated with significant morbidity and mortality across all age groups, yet data on pediatric kidney transplant outcomes associated with COVID-19 positive (COVID +) donors remain limited. Methods: Using the Scientific Registry of Transplant Recipients, we identified 143 pediatric kidney recipients (< 18 years) of COVID + donors transplanted between September 2020 and February 2025 and compared them with 1808 recipients of COVID-19 negative (COVID −) donors using propensity score weighting to account for transplant year, age at transplant, sex, race, human leukocyte antigen mismatch, prior transplant, and immunosuppression. Results: Among 1940 pediatric recipients, 7.3% received kidneys from COVID + donors, with utilization increasing from 2.5% in 2020 to 10.5% in 2025. No statistically significant differences were observed in patient survival (HR 0.83, 95% CI 0.10–6.73, p = 0.86) and overall graft failure (HR 1.35, 95% CI 0.67–2.73, p = 0.41) between COVID + and COVID − groups over a median follow-up of 1.2 years. Delayed graft function (7.7% vs. 7.2%) and median initial hospital stay (8.0 vs. 8.0 days) were also comparable. Conclusions: The use of COVID + donors for pediatric kidney transplantation has increased over time. The posttransplant outcomes are similar between COVID + and COVID − pediatric recipients, supporting the use of COVID + donors in this population.