Pediatric Renal Transplantation in India – A Single Center Experience

Background Renal transplantation is the treatment of choice for children with end-stage renal disease, offering better growth, development, and quality of life when compared to dialysis, but long-term data from India are limited. Materials and Methods We retrospectively reviewed 53 pediatric recipients (<18 years) who underwent kidney transplantation at a South Indian tertiary center between January 2005–2025. Demographics, donor characteristics, immunosuppression, complications, rejection, infections, and survival were analyzed. Survival was estimated by Kaplan-Meier methods. Results The mean age at transplant was 14.9 ± 2.7 years; 62.3% were male. Live-related donor transplants comprised 94.3%. Etiologies included primary glomerular diseases (37.7%) and congenital anomalies of the kidney and urinary tract (26.4%). Anti-thymocyte globulin was the most common induction agent (41.5%), and tacrolimus-based regimens were used in 64.2%. Delayed graft function occurred in 15.1%. Acute rejection was documented in 34%, Antibody-mediated rejection (ABMR) in 60%, T-cell-mediated rejection (TCMR) in 32%, and combined ABMR and TCMR in 8%. Infections occurred in 58.5%, mainly urinary tract and respiratory infections. Graft survival rates at 1, 5, and 10 years were 96.2, 75, and 56%, respectively; patient survival at last follow-up was 73.6%. Conclusion Early graft survival in our setting is comparable to the other series. Long-term outcomes are impacted by infectious complications and chronic rejection.