Renal transplantation

Abstract

Kidney transplantation (KT) is the preferable treatment of end-stage renal disease (ESRD) for adults and children because it increases the patient survival and child growth compared to dialysis and improves the quality of life. The organ shortage still remains the principal limitation to KT, and only living kidney donation (LKD) may overcome it. The living nephrectomy is relatively safe for the donors, and LKD offers a better graft survival than cadaveric kidney donation (CKD). Compared to the adults, the KT in children is a more demanding surgical procedure due to the small size of the vessels and the common discrepancy among the graft and the abdominal space, according to an intraperitoneal transplantation or an extraperitoneal transplantation may be chosen. The immunosuppression scheme improved over the time, but chronic rejection still remains the principal cause of graft loss, and the side effects of calcineurin inhibitor (CNI) and steroids, the principal immunosuppressant, are the daily problems of the pediatrician in the adolescent population. The prevention of rejection, recurrence of disease, and infection is still the principal area of the future research in the pediatric population.