State of pediatric kidney transplantation in 2011

Fifty years ago children with renal failure died due to the lack of adequate therapy. Today, the implementation of dialysis procedures, such as peritoneal dialysis and hemodialysis as well as kidney transplantation, has become almost standard care for pediatric patients. Even infants can now be dialyzed or receive transplants. A kidney transplant allows for a 20-year patient survival in >90% of patients and almost age-appropriate mental and physical development. A better transplant survival is achieved with a living organ donation than with a post-mortem donation. It has been shown that kidneys from deceased juvenile and young adult donors should be allocated primarily to children as they obtain significantly better transplant function in the short and medium term than adults. Unfortunately, the problem of a long waiting period for a postmortem donated kidneys for children in the Eurotransplant area remains. Although, the allocation system for children was amended in December 2010, it remains to be seen whether this change will positively influence waiting times. New immunosuppressive regimens have resulted in significantly improved long-term transplant function and transplant survival. The main challenge, however, concerns chronic humoral transplant rejection, therapy for recurrence of the underlying disease, and the execution of ABO incompatible transplantations.