Pediatric Renal Transplantation

Although the number of children with end-stage renal disease (ESRD) in need for renal transplantationis small compared with adults, the problem associated with renal transplant in childrenare numerous, varied, and often peculiar. Pre-emptive transplantation has recently beengrowing in popularity as it avoids many of the associated long-term complications of ESRDand dialysis. Changes in immunosuppression to more potent agents over the years will haveaffected transplant outcome; there is also evidence that tacrolimus is more effective than cyclosporine.This review will discuss the short- and long-term complications such as acute andchronic rejection, hypertension, infections, and malignancies as well as factors related to longtermgraft function.Chronic allograft nephropathy is the leading cause of renal allograft loss in pediatric renal transplantrecipients. It is likely that it reflects a combination of both immune and nonimmune injuryoccurring cumulatively over time so that the ultimate solution will rely on several approaches.Transplant and patient survival have shown a steady increase over the years. The major causesof death after transplantation are cardiovascular disease, infection and malignancy. Transplantationin special circumstances such as children with abnormal urinary tracts and children withdiseases that have the potential to recur after transplantation will also be discussed in this review.Non-compliance with therapeutic regimen is a difficult problem to deal with and affectspatients and families at all ages, but particularly so at adolescence. Growth may be severelyimpaired in children with ESRD which may result in major consequences on quality of lifeand self-esteem; a better height attainment at transplantation is recognized as one of the mostimportant factors in final height achievement.Although pediatric kidney transplantation is active in some parts of many developing countries,it is still inactive in many others and mostly relying on living donors. The lacking deceasedprograms in most of these countries is one of the main issues to be addressed to adequatelyrespond to organ shortage.In conclusion, transplantation is currently the best option for children with ESRD. Although improvementin immunosuppression demonstrated excellent results and has led to greater 1-yeargraft survival rates, chronic graft loss remains relatively unchanged and opportunistic infectiouscomplications remain a proble