Paediatric renal transplantation--current perspectives

Chronic dialysis is a viable modality for treatment of end-stage renal disease in children, however, its limitation include negative effects on growth, progressive bone disease, and a poorer quality of life. Renal transplantation, on the other hand, allows the child a virtually normal life-style, with good prospects for employment and family life as an adult. Both patient and graft survival are significantly improved in children transplanted in centres with full paediatric facilities where special problems in young children are better addressed, such as that of fluid balance during the perioperative period, the age-related heightened immune responsiveness, and the different pharmacokinetic and pharmacodynamic handling of the various immunosuppressive agents in the child. Moreover, consideration of the problems of growth and developmental is crucial for maximal psychosocial rehabilitation of the paediatric transplant recipient.