Pediatric Kidney Transplantation 2011

As recently as 50 years ago, children suffering from renal insuffiency were dying due to a lack of adequate treatment. Nowadays providing different kinds a dialysis modalities, e. g. peritoneal dialysis and hemodialysis, as well as kidney transplantation have nearly become routine therapeutic options in children. Today, dialysis treatment or kidney transplantation can even be performed in infants.Patient survival of 20 years and near-normal mental and physical development is observed in more than 90% of kidney transplant patients.In comparison to deceased organ donation, living donor organ transplantation leads to better transplant survival. For deceased donation it has been shown that kidneys from deceased children and young adults should be preferably allocated to children because long- and middle term transplant function is significantly better.Long waitlist times for a deceased donor kidney is still a major problem for children throughout the Eurotransplant region. Allocation system for children has been altered in December 2010, however, it remains to be seen whether this alteration will have a positive impact on reducing waitlist times.Development of new immunosuppressive protocols has led to a significant improvement of longterm transplant function and transplant survival. Nevertheless, chronic humoral rejection, treatment of recurrence of underlying condition and performing AB0 incompatible transplantations are major challenges in kidney transplantation.