Pediatric renal transplantation and its challenges

Summary Pediatric renal transplantation poses many challenges, yet successful transplantation is the optimum therapy for children with ESRD. The impediments to success are different and of greater magnitude than seen with adults, primarily because of different and problematic disease causes, distinctly different medical and surgical considerations in small children, and what appears to be an enhanced immune response in smaller children. Nevertheless, excellent results can be obtained in pediatric renal transplantation by strict adherence to surgical detail, tight immunosuppressive management, careful integration of urologic reconstructive surgery with the renal transplant, and aggressive fluid management in the small child. 60 Most important to achieving this success is the management of these patients by an integrated and experienced medical, surgical, and anesthesia team.