Progress in renal transplantation for children

Renal transplantation continues to be the goal of therapy for children with end-stage renal disease. Patient age, primary renal disease, psychosocial status, living versus cadaver donor allograft, immunosuppressive therapy, u rologic status, and maximization of growth and development must be consider ed in determining the optimal time for transplantation. Immunizations shoul d be up to date, and the immune status of both the donor and the recipient with regard to Epstein Barr virus (EBV), cytomegalovirus (CMV), varicella, human immunodeficiency virus (HIV) and Hepatitis A, B, and C must be known. Prednisone; cyclosporine or tacrolimus; and mycophenolate mofetil or azath ioprine remain the mainstays of immunosuppression. However, new therapies s uch as sirolimus are under investigation for use in pediatric renal transpl antation. Induction therapies include T-call antibodies as well as the more recent addition of interleukin-2 receptor blockers. Complications includin g infection, rejection, and malignancy continue to be problematic in pediat ric renal transplantation. There continues to be a strong focus on optimizi ng growth and development after transplant. Although patient and graft surv ival have improved over time, outcomes in pediatric renal transplantation c ontinue to lag behind those in adults. (C) 2000 by the National Kidney Foun dation, Inc.