Overview of pediatric renal transplantation

Over 35 years, renal transplantation in infants and children has evolved dramatically. Once a desperate effort, transplantation is now the therapy of choice for virtually all children with end-stage renal disease (ESRD). The number of children less than 10 years old living with ESRD has more than doubled in the last 7 yr, but during that same interval the children with functioning transplants has quadrupled. Since 1963, 386 children and 21 infants have received 495 renal transplants at the University of Minnesota. When examined, several variables strongly influence the outcomes. Primary renal transplants, grafts from living-related donors, and transplants performed since 1979 have all been associated with markedly improved outcomes. But age of the recipient has no impact on either patient or graft survival. Beneficially, transplanted infants experience significantly accelerated head growth, returning them to the normal range. Their developmental test scores also significantly improve, again bringing them into the normal range. Finally, statural growth regularly improves following successful transplantation. These results support a strategy of early, aggressive support; prompt renal transplantation; and the use of dialysis primarily as a critical 'bridge' to elective transplant surgery.