Complications of paediatric kidney transplantation: a paediatrician's review

Kidney transplantation is the preferred treatment for children with end-stage kidney disease, offering notable improvements in long-term survival and overall quality of life. Nonetheless, paediatric transplant recipients are susceptible to a spectrum of complications that compromise allograft function and overall health. This review highlights key post-transplant complications to aid general paediatricians in recognising and managing these challenges in concert with nephrologists. Early post-transplant complications include surgical issues and electrolyte abnormalities. Infectious complications are most frequent during the first year post-transplant and include viruses such as cytomegalovirus, Epstein-Barr virus and BK virus, as well as urinary tract infections and Pneumocystis jirovecii pneumonia. These infections are largely related to the degree of immunosuppression and require close monitoring. Cardiovascular and metabolic conditions, including hypertension, hyperlipidaemia and post-transplant diabetes mellitus, are also prevalent and contribute to long-term morbidity. These issues often stem from pre-existing kidney disease and ongoing immunosuppressive therapy. Allograft rejection, whether antibody-mediated or T cell-mediated, continues to be a major threat to graft survival. Early detection through donor-specific antibody screening and timely biopsy is essential for prompt intervention. Additional challenges include increased cancer risk, particularly post-transplant lymphoproliferative disorder, and recurrence of primary kidney disease. By recognising these complications early, general paediatricians play a crucial role in multidisciplinary care, improving graft survival and patient outcomes.