Pediatric kidney transplantation in the United States

PURPOSE OF REVIEW: Pediatric kidney transplantation has made great strides over the preceding years. It has become an accepted and successful remedy for thousands of patients worldwide. For best outcomes, it must be viewed and treated as a distinct entity from adult transplantation with focus on the unique challenges particular to its cohort. RECENT FINDINGS: Although efforts have been made to decrease geographic disparity and increase allograft access throughout, an unintended consequence has been prolonged wait times for pediatric patients. Concurrently, ideally size-matched organs from older pediatric donors are also being bypassed. Nevertheless, advances in surgical technique and a better understanding of the limits of donor-recipient pairing have facilitated continued usage of adult kidneys for both infants and small for age children. Immunosuppression optimization has meant mean allograft survival measured in decades. SUMMARY: Enhanced access is needed to better size-matched organs for pediatric recipients, helping diminish wait times for the youngest patients, and improving their long-term prognosis. Longitudinal multicenter studies are needed to help standardize protocols, especially as it relates to optimal surgical and perioperative management. Advances in immunosuppression will continue to enhance patient and graft survival while minimizing adverse effects.