Introduction: At the start of the COVID-19 pandemic paediatric renal transplant recipients(pRTR) in the UK were considered clinically extremely vulnerable and required to shield. The 1st UK lockdown was in March 2020. As the pandemic evolved surrounded by uncertainty, the majority of the transplanting centres in the UK paused their living donor and deceased donor kidney transplantation programmes. In the decade pre-pandemic the mean total number of pRTR in the UK per year was 132(range 119-144) with 73(range 64-91) from live donors.
Method: A retrospective survey was undertaken by the paediatric subgroup of the NHSBT Kidney Advisory Group to assess the impact of pausing transplantation.
Results: Data was returned from 8/10 centres.
Living donor transplantation: 
21 patients(pts) with dates for transplants were cancelled (median(range) per centre 2.5,0-5).
12 pts had offers through the UK kidney sharing scheme(UKKSS). In 4/12 pts the transplant did not proceed. 
8 pts with offers in the UKKSS had their transplants scheduled between June and October 2020.
2 pts due pre-emptive renal transplants from living donors commenced dialysis in view of the delays.
In 14 cases the paediatric recipient and donor had completed work up for a living donor renal transplant by April 2020 but not offered transplantation date during the time the living donor programme was suspended. 1/14 patients started dialysis.
By the end of 2020 17/21 of the recipients with dates scheduled for transplantation that were postponed at the start of the pandemic had completed transplantation (in one case after a 3 month delay in view of donor weight gain). Of the 4 pts not transplanted, in 3 cases the families elected to delay until a later date and 1 child sadly died prior to their transplantation date.
Deceased donor transplantation: 91 pts from 7 centres were on call for deceased donor renal transplant at the start of March 2020. 86/91 pts were suspended on call by April 2020. In the 5 cases who remained on call, 2 pts had very difficult dialysis access, 1 was a long waiter, 1 access difficulties and poor matchability. The final child remained on call for a combined liver and kidney transplant. 
10 additional pts from 3 of the centres completed their recipient work ups during the period the transplant programme was suspended and not activated on call. Two units commented there were delays in the work ups due to the pandemic and redeployment of staff.
Of the 86 pts suspended on call by April 2020, all but 4 pts were reactivated later in 2020. In 3 cases this was the families’ preference. The other case was for medical reasons in a child requiring intensive care post-transplant.
Conclusion: This national report demonstrates the disruption to UK paediatric kidney transplant programmes early on during the COVID-19 pandemic. Notably the number of children on dialysis in the UK increased significantly (by approximately 40% in registry data) following this period with the pandemic being a contributing factor.