PURPOSE: The use of small pediatric kidneys obtained from very young donors after cardiac death (DCD) has been limited and this remains an underutilized organ source. MATERIALS AND METHODS: We reviewed all renal transplants at our institution from 2000 to 2013 to identify recipients of an en-bloc pair of kidneys from pediatric donors less than 4 years of age. The outcomes of DCD en-bloc allografts were compared with neurologic determination of death (NDD) en-bloc allografts. RESULTS: 21 recipients of en bloc renal allografts were identified of which 4 organ pairs were obtained through DCD. The mean donor age was 20.6 ± 11.6 months and mean donor weight was 12.4 ± 3.7 kg. Delayed graft function (DGF) occurred in 2/4 DCD and 3/17 NDD en bloc recipients. At one year post-transplantation, mean glomerular filtration rates (GFRs) were similar at 80.7 ± 15.3 versus 85.7 ± 33.4 mL/min/1.73 m2 in the DCD and NDD groups respectively (p = NS). Surgical complications occurred in three patients; no grafts were lost to thrombosis. CONCLUSIONS: We are encouraged to report successful transplantation of a small cohort of DCD pediatric en-bloc kidneys from donors less than 4 years of age. Outcomes at one year are comparable to NDD en bloc allograft recipients.