OBJECTIVE The optimal use of kidneys from small pediatric cadaveric donors remains controversial. The aim of this study was to analyze short-term graft and patient survivals of en bloc kidney transplantations compared with single cadaveric adult donor kidney transplantations. METHODS We compared the 1-year evolution of 14 adult recipients of en bloc pediatric kidney donors (EBKT) of median age 13.5±14.5 months (range=3 days to 48 months) with 182 recipients of ideal adult cadaveric donors (ADT) showing a median age of 30±21 years (range=14-45 years). RESULTS Besides the different age and weight of the donors, EBKT recipients were more commonly women (P=.05) and received thymoglobulin induction treatment (P=.00). Delayed graft function was higher in EBKT (46.2% vs 22.2%, P=.05), with no differences in the incidences of acute rejection episodes. Mean serum creatinine values at 3, 6, and 12 months after transplantation were 1.1±0.3, 1.1±0.2, and 1.0±0.2 mg/dL in the EBKT group, compared with 1.3±0.5 (P=.16), 1.3±0.5 (P=.02), and 1.3±0.6 (P<.01) in the ADT group. Vascular allograft complications were more frequent among EBKT. Graft survival rate at 1 year was 92% in both groups, with no differences in patient survival (100% in EBKT vs 92% in ADT; P=.49). CONCLUSIONS EBKT from small pediatric donors show excellent graft function and 1-year survival and should be considered for transplantation into adults.