Pediatric patients with end-stage renal disease wait longer for KT due to shortage of organs and ultra-selection of donors so that they are age- and size-matched. KT from adult donors is reported to be associated with technical difficulties, complications, and poorer graft survival. We aimed to determine the outcomes of low weight patients who received kidneys from adult donors through extraperitoneal approach. We perform around 40 pediatric transplants/year, mostly from adult donors. Patients were divided into the (LWC: weight < 15 kg) and (HWC: ≥15 kg). From January 2011 to June 2017, 213 patients received KT. KT procedures were performed through extraperitoneal approach. Mean age of recipients was 10 years (5 years and 12 years for LWC and HWC, respectively) and 32 years for donors. Mean weight of recipient was 26 kg (13 kg and 31 kg for LWC and HWC, respectively) and 70 kg for donors. Mean follow-up was 5.5 years. Acute rejection occurred in 18% and delayed graft function in 5%. Three patients died during follow-up. Graft survival at 1 year was 97% and 82% at 5 years. Length of stay (P = .57), surgical complications (P = .74), long-term graft survival (P = .35), and GFR at 5 years (P = .59) were similar in both groups. This study shows that low weight pediatric patients can be transplanted from adult donors with low surgical complications and with favorable patient and graft survival. Extraperitoneal approach is feasible and safe in low weight recipients.© 2020 Wiley Periodicals LLC.