Pediatric priority in kidney allocation after age 18

Children registered for kidney transplant prior to age 18 years retain ‘pediatric’ allocation status after their 18th birthday. There are no data on the impact of this policy. We performed a retrospective cohort study of 7097 candidates listed for kidney transplant prior to age 18 years who remained on the wait list after their 18th birthday between 1/1/2015 and 4/1/2022 using United Network for Organ Sharing data. 1193 candidates remained on the wait list after their 18th birthday. Median age at listing was 17 years (IQR 17-17 years). 588 candidates (8% of 7097 pediatric candidates) received a kidney transplant with pediatric status at age 18 or older; 465 (79%) were deceased donor transplants. Median age at deceased donor transplant was 18 years (IQR 18-19 years); 97% were performed before the age of 21. In 7.25 years of the study, 12 adults 21 and older received a deceased donor kidney transplant with pediatric allocation priority. Deceased donor transplant with pediatric priority after age 18 is rare, comprising an estimated 0.4% of all adult deceased-donor transplants. Candidates with pediatric priority after age 18 typically progress to transplant within 3 years. Ongoing monitoring of this population is important to fully understand allocation policy.