Pediatric kidney transplantation: options and decision making

Abstract

Only 30 years ago, most children with terminal renal failure did not survive. Modern dialysis therapies (perotineal dialysis and hemodialysis) allow an adequate renal-replacement therapy for children today. The better alternative for children is kidney transplantation, which can be carried out even in small infants, leading to better survival and psychosocial development as well as allowing normal school education. Many allocation systems have increased the priorities for children but even more efforts have to be made to decrease waiting time for pediatric kidney recipients. A primary allocation of kidneys from children and young adults for pediatric recipients might be an important part of the solution of this problem. New immunosuppressive protocols have significantly increased long-term graft function and survival. Living donation, most often performed by the parents, is associated with better survival than donation of organs from deceased donors. In cadaveric donation, organs from pediatric or young adult donors should be preferentially allocated to children due to better future graft function. Pediatric kidney transplantation leads to a good psychosocial outcome for children with end-stage renal disease.