Introduction: Living donation (LD) offers superior outcomes compared to deceased donor (DD) transplantation for patients with ESRD.  In the US, an increment in LD rate was observed until 2001 and 2004, when LD rates began to decrease in peds and adult renal transplants (KTx), respectively. Knowledge about LD trends among children who have received KTx in PR is limited. We describe LD trends among pediatric KTx performed in PR from 1977-2013.

Methods: Retrospective chart review of all children (0-18yrs) receiving KTx in PR from 1977-2013. Median (range) frequencies (percentages) were calculated.

Results: From 1977-2013, 146 children, female: 39%, Hispanic: 100%, age: 14yrs (2-18yrs) were transplanted. 60% received LD and 40%DD. 75%LD were parents, 13%LD siblings, and 1%LD unrelated. 16%DD were from the US. Total number of transplants remained stable from 1980-2000 (1977-79: 5 KTx, 1980’s: 40 KTx, 1990’s: 40 KTx, 2000’s: 45 KTx, 2010-13: 16 KTx). LD rate decreased over time (77-79: 100%, 80’s: 85%, 90’s: 75%, 00’s: 31%, 10-13: 12%). 6%pts received 2nd KTx at 21yrs or younger, with 67% and 33% LD on 1st and 2nd KTx, respectively. Of these pts, female: 44%, age at first KTx: 12yrs(5,18yrs), and age at 2nd KTx: 17yrs(13-21yrs).

Conclusions: Living donation in pediatric renal transplants has substantially declined in PR over the last 4 decades. Possible explanations include single parenting, medical unsuitability, shifting practice patterns (i.e. establishment of solid organ procurement organizations), and marketing strategies, among others. Additional studies are needed to better understand the causes of such decline and to develop strategies to increase LD among our children with ESRD.