[Kidney transplantation in pediatric age.]

Area of Science:

• Pediatric Nephrology
• Transplant Surgery
• Immunology

Background:

• Kidney transplantation (KT) is the optimal treatment for pediatric end-stage renal disease, surpassing dialysis in mortality and quality of life.
• Broadened inclusion criteria reflect improvements, yet histocompatibility and donor source remain critical for graft longevity.
• Pediatric KT presents unique challenges, including donor-recipient size discrepancies, growth impact, and adherence issues.

Purpose of the Study:

• To review the current status and outcomes of kidney transplantation in children.
• To identify key factors influencing graft survival and patient mortality.
• To highlight areas for future research, focusing on immunological tolerance and reduced immunosuppression.

Main Methods:

• Review of recent literature on pediatric kidney transplantation outcomes.
• Analysis of factors affecting graft and patient survival, including donor type and rejection.
• Examination of common causes of graft loss and mortality in the first post-transplant years.

Main Results:

• Five-year graft survival rates are 90% for living donor KT and 70% for cadaveric donor KT.
• Chronic rejection is the primary cause of graft loss.
• Mortality within the first post-transplant years is below 6.5%, with infections and cardiovascular issues being leading causes of death.

Conclusions:

• Pediatric kidney transplantation outcomes have significantly improved, approaching adult results.
• Reducing immunosuppression and managing chronic rejection are crucial for enhancing long-term graft function.
• Further research into achieving immunological tolerance is essential for improving pediatric KT success rates.