Kidney transplantation in children.

Over the past decade, the success rate of pediatric kidney transplantation has dramatically increased, based on improvements in histocompatibility testing, immunosuppressive management, and diagnosis and treatment of rejection. The 1-year graft survival rate now approaches 90%. The optimal age for recipients as well as for donor organs is greater than six years. Recurrence of primary disease in the graft accounts for approximately 5% graft loss in children. Sequential immunosuppressive protocols have been particularly successful in children, and maintenance immunosuppression routinely includes corticosteroids, azathioprine, and cyclosporin A. Posttransplantation complications include rejection, infection, hypertension, growth retardation, and noncompliance.