PEDIATRIC KIDNEY-TRANSPLANTATION

Renal transplantation is the optimal form of renal replacement therapy leading to substantial improvement in the quality of life. It has rap idly become the standard treatment for end-stage renal disease in chil dren. However, despite impressive short-term results significant long- term problems remain unsolved. Because of the lack of effective treatm ent for chronic rejection and common recipient noncompliance, allograf t half-life has not improved significantly during the last decade. A p aediatric recipient is likely to need several retransplantations in ad ulthood. Moreover, the immunosuppressive drugs used today have potenti ally serious side-effects including nephrotoxicity and de novo maligna ncy. These are especially relevant for paediatric recipients who will continue to receive therapy for several decades. Most therapeutic prot ocols used for children are derived from those used for adults. Howeve r, the metabolic differences between an adult and a growing and develo ping paediatric transplant recipient are not always adequately appreci ated before these new therapies are initiated. In the near future, we are likely to see new and more efficient drugs become available. It is important that we try to understand their properties in children and use them and our current arsenal on an individual basis aiming at opti mal graft survival but also at avoiding unnecessary adverse effects.