[Kidney transplantation in childhood: from milimeter to centimeters]

Area of Science:

• Pediatric nephrology
• Transplant surgery
• Vascular biology

Context:

• Graft survival is significantly poorer in pediatric kidney transplant recipients younger than 5 years.
• Vascular thrombosis presents a major complication in this age group, negatively affecting graft longevity.
• Optimizing growth and achieving normal height are critical goals in managing children post-transplantation.

Purpose:

• To highlight the increased risk of vascular thrombosis in young pediatric kidney transplant recipients.
• To outline preventive strategies for vascular thrombosis, including donor selection, surgical technique, hemodynamic management, and anticoagulation.
• To assess the impact of transplantation on the growth and final height of pediatric recipients.

Summary:

• Younger recipients (<5 years) experience worse graft survival due to heightened vascular thrombosis risk.
• Preventive measures for thrombosis include careful donor choice, surgical methods, hemodynamic optimization, and anticoagulation.
• Final height in transplanted children has improved over the last two decades, ranging from -1.63 to -0.92 SDS.

Impact:

• Improved understanding of risk factors for graft failure in young transplant recipients.
• Guidance on implementing effective thrombosis prevention protocols in pediatric transplantation.
• Evidence of progress in achieving better growth outcomes for children following kidney transplantation.