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Background: The organ shortage is the main concern for kidney transplantation. Using deceased pediatric donors either as single or in an en-bloc manner is one way to solve this problem. We reviewed 21 en-bloc pediatric deceased kidney transplantations to adult recipients. Methods: From May 2010 to May 2016, 472 deceased kidney transplantations have been performed in our hospitals. Twenty-one of these were pediatric kidney transplantations to adult recipients (age < 5 years, kidney size < 8 cm, donor weight <15 kg). Follow-up (ranging from 3 to 36 months) included clinical findings and complications plus serial creatinine levels and kidney size with ultrasonography and dimercaptosuccinic acid renal scan. Results: Among 21 patients, 52.4% were female. The mean age of participants was 28.85 ± 10.29 years. The preoperative mean size of the grafts was 6.94 ± 0.58 centimeters reaching 8.52 ± 0.98 and 10.20 ± 1.2 after 3 and 12 months of postoperative follow-up, respectively (P-value < 0.001). Means of serum creatinine was 1.61 ± 0.39, 1.45 ± 0.39, 1.32 ± 0.37, and 1.17 ± 0.28 mg/dl at postoperative 1, 3, and 6 and 12 months, respectively (P-value < 0.001). In a 12-month follow-up (range, 3 to 36 months), the complication-free rate was 61.9%, one-year patient survival was 90.5%, and one-year graft survival was 100%. Conclusion: En-bloc pediatric deceased kidney transplantation is an acceptable alternative for adult recipients, with a great midterm patient and graft survival. Longer follow-up is recommended to assess their long-term outcomes. [ABSTRACT FROM AUTHOR]