Renal transplantation of children with
chronic renal insufficiency (CRI) and
end-stage renal disease (
ESRD) appears to be the optimal form of
renal replacement therapy. This report, which expresses the opinions of the nephrology members of the Pediatric Committee of the American Society of Transplant Physicians, discusses the indications for pediatric
renal transplantation and identifies the unique aspects of caring for children with CRI and
ESRD. Indications for pediatric
renal transplantation include: 1) symptoms of
uremia not responsive to standard
therapy; 2)
failure to thrive due to limitations in total caloric intake; 3) delayed psychomotor development; 4) hypervolemia; 5)
hyperkalemia; and 6)
metabolic bone disease due to
renal osteodystrophy. The urgency and timing of
renal transplantation in children must be considered in the context of a number of issues unique to children with CRI and
ESRD such as delayed cognitive and educational performance, growth retardation,
delayed puberty, etiology of
ESRD, and timing of immunizations. In addition, these children frequently display various inherited and sporadic syndromes with multiorgan involvement requiring the expertise of a variety of pediatric subspecialists including the pediatric urologist, who plays a critical role in the evaluation of children with obstructive uropathy and other anomalies of the genito-urinary system. The advantages of a living-related donor are also delineated. The importance of adequate immunosuppression on graft function, early recognition of the signs and symptoms acute rejection, preventive strategies for minimizing the morbidity and mortality from
viral infections in the post-transplant period, and the impact of
transplantation on cognitive function, educational status, and catch-up growth are also discussed. To address these complex issues, transplant care of pediatric patients must be provided by a multidisciplinary team of pediatric health care professionals.