Kidney transplantation remains the preferred treatment for pediatric and adolescent patients with end-stage kidney disease, offering improved growth, pubertal development, survival, and quality of life. Using data from the United States Renal Data System (USRDS), this study compared demographics and outcomes between adolescent (14–18 years) and young adult (19–25 years) kidney transplant recipients whose first transplant occurred in 2000 or later. Statistical analyses assessed differences in donor type, graft survival, transplant failure, and mortality between groups.

Among 13,135 total patients, adolescents were more likely than young adults to be wait-listed (60.8% vs. 39.4%; p<0.0001) and receive a transplant (71.8% vs. 33.3%; p<0.0001). However, adolescents had higher rates of first transplant failure (26.5% vs. 20.6%; p<0.0001) and a younger mean age at failure (23.3 vs. 28.8 years; p<0.0001). Graft and transplant survival rates were high in both groups, exceeding 97% at one year and 84–89% at five years, with slightly better outcomes in living donor transplants. Adjusted one- and five-year graft survival among adolescents and young adults surpassed that of adults for both living and deceased donor recipients. Despite these favorable graft survival trends, overall mortality and post-failure survival times were comparable between adolescents and young adults.

These findings highlight the persistent vulnerability of adolescent kidney transplant recipients to early graft loss, emphasizing the importance of enhanced transition support, adherence interventions, and donor-specific management strategies. Efforts to address psychosocial and systemic barriers may further improve long-term outcomes in this high-risk population