Introduction: Our centre performs around 20 paediatric kidney transplants per year, including patients cared for by another centre. In March 2020, the WHO declared Covid-19 a Pandemic. Due to rapidly rising Covid cases, multiple centres including our own, halted both their living and deceased donor kidney transplant (LDKT/DDKT) programs. In order to re-establish the paediatric renal transplant service within our centre, amidst an ongoing pandemic, we worked collaboratively with teams across our own and other healthcare Trusts to ensure safe & successful outcomes for this vulnerable patient population.  Due to the structural complexity of the wider transplant surgical team, who cover not only ourselves but also an adult and a separate Trust’s paediatric transplant program, we faced multiple challenges in ensuring our own program was effectively restarted whilst upholding our centre's ethos.   
Methods: In order to formulate a Covid-19 standard operating protocol (SOP) for renal transplantation we initially posed questions internally relating to overall safety, how to group patients and which arm of the transplant program (LDKT/DDKT) should recommence first. We also asked our families for their opinions regarding transplanting their children at this time. This helped to inform our detailed pandemic-specific protocol. We proceeded to group patients based on clinical priority and readiness for transplant. These groups were discussed regularly in multi-centre multi-disciplinary team meetings, with special considerations relating to recipient age, weight, clinical complexity and stability of dialysis access. Questionnaires were completed with families to better understand social circumstances initially and later to monitor potential Covid symptoms and ongoing eligibility for transplant.   
Results: Our DDKT program, followed by our LDKT program, were reopened in June 2020 in incremental stages and were both open to all patients by September 2020. Our LDKT program was temporarily halted from January – March 2021 due to a nationwide surge in Covid-related hospitalisations at this time. Between June 2020 and March 2021 we performed 14 transplants for paediatric recipients. Of these, 11 were LDKTs (1 UK Living Kidney Sharing Scheme (UKLKSS)) and 3 were DDKTs. Between April 2021 and March 2022 we performed 29 transplants for paediatric recipients. Of these, we performed 22 LDKTs (1 UKLKSS, 1 altruistic non-directed donor) and 7 DDKTs. 100% graft & patient survival rate was achieved.   
Conclusion: The Covid-19 pandemic presented novel challenges in the field of paediatric renal transplantation. Re-starting our transplant program required a great deal of multi-disciplinary time and team-working, as well as collaborative work with patient groups to fully gauge familial emotions and ensure patient safety and trust was upheld. As a service we continue to develop our protocols in line with the evolving nature of the pandemic and the needs of our patient group.