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Challenges and outcomes in pediatric and adult kidney transplantation

Viola Weeda1, Nikolaos Koliakos2, Thomas Caës3

  • 1Department of Pediatric Surgery, Queen Fabiola Children's University Hospital, HUDERF, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium.

Frontiers in Pediatrics
|May 14, 2026
PubMed

Insights

Kidney transplantation requires different approaches for adults and children. Tailored evaluations, surgical techniques, and postoperative care are crucial for optimizing graft survival and quality of life in both pediatric and adult kidney transplant patients.

Area of Science:

  • Nephrology
  • Transplantation Surgery
  • Pediatric Medicine

Background:

  • Kidney transplantation management differs significantly between adult and pediatric populations.
  • Pediatric focus includes growth, congenital anomalies (Congenital Anomalies of the Kidney and Urinary Tract - CAKUT), and neurodevelopment.
  • Adult focus emphasizes cardiovascular health, malignancy risk, comorbidities, and frailty.

Purpose of the Study:

  • To outline the distinct preoperative and postoperative considerations for adult versus pediatric kidney transplantation.
  • To highlight differences in surgical techniques and common postoperative complications.
  • To emphasize the need for life-stage-specific, multidisciplinary care.

Main Methods:

  • Comparative analysis of adult and pediatric kidney transplant protocols.
  • Review of surgical adaptations for pediatric patients.
  • Examination of differing postoperative complication profiles and management strategies.

Main Results:

  • Pediatric evaluations prioritize growth and congenital issues; adult evaluations focus on comorbidities and frailty.
  • Pediatric surgery requires size-adapted techniques (e.g., microvascular anastomosis).
  • Adults have higher rates of delayed graft function; children face unique vascular risks and adherence challenges. Urinary tract infections are common in both.

Conclusions:

  • Successful kidney transplantation necessitates distinct, multidisciplinary, life-stage-specific strategies.
  • Addressing immunological risks alongside developmental or disease trajectories is key.
  • Optimizing graft survival and quality of life requires tailored care for pediatric and adult kidney transplant recipients.

Keywords:
kidney transplantationpediatric transplantationpostoperative managementpreoperative evaluationsurgical complications

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