Renal transplantation is the treatment of choice for children with end-stage renal disease as it
results in better survival rates and quality of life compared to dialysis. The pediatric transplant population
represents a unique population whereby patients undergo rapid phases of growth and development, not only
physically but also mentally and psychologically. This chapter provides an overview of the current trends
and issues pertaining to pediatric renal transplantation. These issues include the discrepancy in size between
the young recipient and the large adult-sized kidney, variations in the development of the immune response,
specific pediatric considerations in immunosuppressive regimens, non-adherence in adolescence, and the
greater propensity for infections and viral-driven lymphoproliferative disorders, growth failure and longterm
cardiovascular disease. Recurrence of the primary renal disease, especially focal segmental
glomerulosclerosis, is a significant concern in pediatric renal transplantation, as this often results in graft
loss. Patients with abnormal urinary tracts will need evaluation and often surgical correction prior to
transplant. Advances in immunosuppression regimens and surgical techniques in the last two decades have
dramatically improved short and medium-term patient and graft survival outcomes in pediatric renal
transplantation. Long-term graft survival, however, remains suboptimal, due to calcineurin inhibitor toxicity,
cardiovascular disease, infections and non-adherence. Therefore the current challenge in pediatric renal
transplantation will be to improve long-term graft survival by minimizing the side effects of
immunosuppression while preventing rejections. There are trends towards steroid and/or calcineurin
inhibitor-sparing immunosuppressive regimens, with the use of non-depleting or depleting monoclonal and
polyclonal antibodies as induction therapy.
Keywords: Immunosuppressive Regimens, Induction Therapy, Monoclonal Antibodies, Polyclonal
Antibodies, Growth Failure, Non-Adherence, Tacrolimus, Cyclosporine, Acute Rejection, Living Donor.
