BACKGROUND: Pediatric kidney transplantations are rarely performed, and there is limited knowledge about the diversity in current clinical practices across Europe. This study aims to explore the utility of clinical snapshot studies in identifying these disparities, establishing a foundation for future snapshot studies and standardization efforts. METHODS: A pilot clinical snapshot study was conducted, with invitations extended to all 109 pediatric kidney transplant centres in Europe. Each participating centre provided pre-, peri-, and postoperative data concerning their most recent thirty transplantations. The primary outcomes encompassed the evaluation of disparities in donor-recipient selection, surgical techniques, post-operative drainage procedures, and immunosuppressive therapy protocols. Secondary outcomes involved the analysis of rejection rates, incidence of infections, and graft survival. RESULTS: The study involved 439 patients from fifteen centres (14%) in twelve countries, with varying transplant volumes (range 1-29 transplantations per year) and follow-up periods. Significant differences were found among centres in terms of donor types, cold and warm ischemia time, pre-emptive transplant rates, and kidney transplant drainage methods. The rate of living donors varied between 3% and 90% and the median duration of cold ischemia ranged was 770 min after deceased donation and 147 min after living donation. Basiliximab was the dominant induction therapy, yet steroid withdrawal varied widely. Infection, rejection, and graft survival rates also varied significantly between centres. CONCLUSION: This study revealed substantial variation in clinical practices among European centres performing pediatric kidney transplantations. These findings could serve as a stimulus for international dialogue and collaboration.

1st Dept Pediatric Children's Hospital Comenius University Bratislava Slovakia

Department of Nephrology Kidney Transplantation and Hypertension Children's Memorial Health Institute Warsaw Poland

Department of Paediatric Nephrology and Rheumatology Ghent University Hospital ERKNet Centre Ghent Belgium

Department of Pediatric Nephrology Centro Materno Infantil do Norte Centro Hospitalar Universitário de Santo António Porto Portugal

Department of Pediatric Nephrology Emma Children's Hospital Amsterdam University Medical Center Amsterdam Netherlands

Department of Pediatric Nephrology Radboudumc Amalia Children's Hospital Nijmegen Netherlands

Department of Pediatric Nephrology University Hospital of Réunion La Réunion France

Department of Pediatric Surgery Hospital Sant Joan de Déu Universitat de Barcelona Barcelona Spain

Department of Pediatric Urology University Hospital La Paz Madrid Spain

Department of Pediatrics 2nd Faculty of Medicine Charles University and Motol University Hospital Prague Czechia

Department of Pediatrics Pediatric Nephrology Beatrix Children's Hospital University of Groningen University Medical Centre Groningen Groningen Netherlands

Department of Pediatrics Vilnius University Hospital Santaros Klinikos Vilnius Lithuania

Department of Urology and Pediatric Urology Universitätsklinikum Erlangen Friedrich Alexander Universität Erlangen Nürnberg Erlangen Germany

Department of Visceral Transplant and Thoracic Surgery Medical University of Innsbruck Innsbruck Austria

Division of Pediatric Urology Department of Urology Radboudumc Amalia Children's Hospital Nijmegen Netherlands

IQ Health Science Department Radboudumc Nijmegen Netherlands

Pediatric Nephrology Dialysis and Transplant Unit Department of Women's and Children's Health Padua University Hospital Padua Italy

Pediatric Urology and Renal Transplant Unit Department of Pediatric Surgery University Hospital Vall d´Hebron Barcelona Barcelona Spain

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