Pediatric End-stage Renal Disease Research Articles

Considerable variations in growth hormone policy and prescription in paediatric end-stage renal disease across European countries-a report from the ESPN/ERA-EDTA registry.

Growth retardation in paediatric end-stage renal disease (ESRD) has a serious impact on adult life. It is potentially treatable with recombinant growth hormone (rGH). In this study, we aimed to quantify the variation in rGH policies and actual provided care in these patients across Europe. Renal registry representatives of 38 European countries received a structured questionnaire on rGH policy. Cross-sectional data on height and actual use of rGH on children with ESRD aged <18 years were retrieved from the ESPN/ERA-EDTA Registry. In 21 (75%) of 28 responding countries, rGH is reimbursed for children with ESRD. The specific conditions for reimbursement (minimum age, maximum age and chronic kidney disease stage) vary considerably. Mean height standard deviation scores (SDS) at renal replacement therapy (RRT) [95% confidence interval (CI)] were significantly higher in countries where rGH was reimbursed -1.80 (-2.06; -1.53) compared with countries in which it was not reimbursed [-2.34 (-2.49;-2.18), P < 0.001]. Comparison of the mean height SDS at onset of RRT and final height SDS yielded similar results. Among the 13 countries for which both data on actual rGH use between 2007 and 2011 and data from the questionnaire were available, 30.1% of dialysis and 42.3% of transplanted patients had a short stature, while only 24.1 and 7.6% of those short children used rGH, respectively. Reimbursement of rGH associates with a less compromised final stature of ESRD children. In many countries with full rGH reimbursement, the actual rGH prescription in growth-retarded ESRD children is low and obviously more determined by the doctor's and patients' attitude towards rGH therapy than by financial hurdles.

Disparities in treatment rates of paediatric end-stage renal disease across Europe: insights from the ESPN/ERA-EDTA registry.

Considerable disparities exist in the provision of paediatric renal replacement therapy (RRT) across Europe. This study aims to determine whether these disparities arise from geographical differences in the occurrence of renal disease, or whether country-level access-to-care factors may be responsible. Incidence was defined as the number of new patients aged 0-14 years starting RRT per year, between 2007 and 2011, per million children (pmc), and was extracted from the ESPN/ERA-EDTA registry database for 35 European countries. Country-level indicators on macroeconomics, perinatal care and physical access to treatment were collected through an online survey and from the World Bank database. The estimated effect is presented per 1SD increase for each indicator. The incidence of paediatric RRT in Europe was 5.4 cases pmc. Incidence decreased from Western to Eastern Europe (-1.91 pmc/1321 km, P < 0.0001), and increased from Southern to Northern Europe (0.93 pmc/838 km, P = 0.002). Regional differences in the occurrence of specific renal diseases were marginal. Higher RRT treatment rates were found in wealthier countries (2.47 pmc/€10 378 GDP per capita, P < 0.0001), among those that tend to spend more on healthcare (1.45 pmc/1.7% public health expenditure, P < 0.0001), and among countries where patients pay less out-of-pocket for healthcare (-1.29 pmc/11.7% out-of-pocket health expenditure, P < 0.0001). Country neonatal mortality was inversely related with incidence in the youngest patients (ages 0-4, -1.1 pmc/2.1 deaths per 1000 births, P = 0.10). Countries with a higher incidence had a lower average age at RRT start, which was fully explained by country GDP per capita. Inequalities exist in the provision of paediatric RRT throughout Europe, most of which are explained by differences in country macroeconomics, which limit the provision of treatment particularly in the youngest patients. This poses a challenge for healthcare policy makers in their aim to ensure universal and equal access to high-quality healthcare services across Europe.

Zystennieren im Kindesalter

Even though cysts in the kidney are a rare finding in childhood and adolescence, cystic kidney diseases are among the most common and the most important causes of pediatric end stage renal disease. While kidney cysts are a frequent and usually benign finding in adults, the detection of even a single renal cyst is a serious finding in children and should lead to a systematic follow-up looking for a potentially underlying cystic kidney disease. Even a few straightforward parameters, such as a detailed family history and a renal ultrasound examination can give important hints for the right clinical diagnosis. Given the different clinical courses and the diverging extrarenal manifestations of the diverse cystic kidney disease entities, establishing the exact diagnosis is crucial. This article aims to help the reader with insights into a targeted diagnostic work-up for the differential diagnosis of renal cysts.

Analysis of Cardiorenal Physiological Dysfunction in a Mouse Model of Neonatal‐lethal Congenital Obstructive Nephropathy

Congenital obstructive nephropathy is the most common cause of pediatric chronic kidney disease and end stage renal disease. This disease is caused by obstruction of the urinary tract during fetal development and most commonly occurs at the ureteropelvic junction (UPJ), where the renal pelvis transitions into the ureter. The exocyst is a highly‐conserved 8‐protein trafficking complex and we recently generated a novel conditional knockout mouse for the central exocyst subunit, Sec10 (Sec10‐CKO). Upon Sec10 deletion in the developing kidney and ureter epithelial cells, the mice displayed late‐gestational congenital UPJ obstructions that caused death 10‐14 hours after birth. To further investigate the physiological consequences of these lethal urinary obstructions, cardiorenal and pulmonary parameters were compared in wild‐type and mutant newborn littermates. Upon necropsies, atrial distension with severe hemorrhaging was grossly visible in the mutants compared to littermate controls, which was also confirmed with histological analysis. We performed M‐mode and Doppler echocardiography on the hearts of newborn mice, which indicated signs of diastolic dysfunction. Assessment of newborn lung mass and surface area showed no significance between control and mutant mice. Although our analysis is ongoing, these preliminary results suggest this new mouse model may be a useful tool in studying the cardiovascular consequences of severe urinary obstructions in humans.

Antibody-mediated rejection in pediatric kidney transplantation: pathophysiology, diagnosis, and management.

Kidney transplant is the preferred treatment of pediatric end-stage renal disease. One of the most challenging aspects of pediatric kidney transplant is the prevention and treatment of antibody-mediated rejection (ABMR), which is one of the main causes of graft dysfunction and early graft loss. Most challenges are similar to those faced in adult kidney transplants; however, factors unique to the pediatric realm include naivety of the immune system and the small number of studies and randomized controlled trials available when considering pharmacological treatment options. Here, we present a case of ABMR in a pediatric patient and a review of the pathophysiology, diagnosis, and management of ABMR. ABMR in pediatric kidney transplant continues to be a frustrating condition to treat because (1) there still remain many unidentified potential antigens leading to ABMR, (2) children and adults are at different stages of their immune system development, and, thus, (3) the full pathophysiology of alloimmunity is still not completely understood, and (4) the efficacy and safety of treatment in adults may not be directly translated to children. As we continue to gain a better understanding towards the precise alloimmune mechanism that drives a particular ABMR, we can also improve pharmacotherapeutic choices. With continued research, they will become more precise in treating a particular mechanism versus using a broad scope of immunosuppression such as steroids. However, there is much more to be uncovered, such as identifying more non-human leukocyte antigens and their role in alloimmunity, determining the exact mechanism of adults achieving complete operational tolerance, and understanding the difference between pediatric and adult transplant recipients. Making strides towards a better understanding of these mechanisms will lead to continued efficacy and safety in treatment of pediatric ABMR.

One-Year Mortality Rates in US Children with End-Stage Renal Disease

Background/Aims: Few published data describe survival rates for pediatric end-stage renal disease (ESRD) patients. We aimed to describe one-year mortality rates for US pediatric ESRD patients over a 15-year period. Methods: In this retrospective cohort study, we used the US Renal Data System database to identify period-prevalent cohorts of patients aged younger than 19 for each year during the period 1995-2010. Yearly cohorts averaged approximately 1,200 maintenance dialysis patients (60% hemodialysis, 40% peritoneal dialysis) and 1,100 transplant recipients. Patients were followed for up to 1 year and censored at change in modality, loss to follow-up, or death. We calculated the unadjusted model-based mortality rates per time at risk, within each cohort year, by treatment modality (hemodialysis, peritoneal dialysis, transplant) and patient characteristics; percentage of deaths by cause; and overall adjusted odds of mortality by characteristics and modality. Results: Approximately 50% of patients were in the age group 15-18, 55% were male, and 45% were female. The most common causes of ESRD were congenital/reflux/obstructive causes (55%) and glomerulonephritis (30%). One-year mortality rates showed evidence of a decrease in the number of peritoneal dialysis patients (6.03 per 100 patient-years, 1995; 2.43, 2010; p = 0.0263). Mortality rates for transplant recipients (average 0.68 per 100 patient-years) were consistently lower than the rates for all dialysis patients (average 4.36 per 100 patient-years). Conclusions: One-year mortality rates differ by treatment modality in pediatric ESRD patients.

Racial and ethnic disparities in pediatric renal allograft survival in the United States

This study was undertaken to describe the association of patient race/ethnicity and renal allograft survival among the national cohort of pediatric renal allograft recipients. Additionally, we determined whether racial and ethnic differences in graft survival exist among individuals living in low or high poverty neighborhoods and those with private or public insurance. Among 6,216 incident, pediatric End Stage Renal Disease patients in the United States Renal Data System (kidney transplant from 2000 through September, 2011) 14.4% experienced graft failure, with a median follow-up time of 4.5 years. After controlling for multiple covariates, black race, but not Hispanic ethnicity, was significantly associated with a higher rate of graft failure for both deceased and living donor transplant recipients. Disparities were particularly stark by 5 years post-transplant, when black living donor transplant recipients experienced only 63.0% graft survival compared with 82.8% and 80.8% for Hispanics and whites, respectively. These disparities persisted among high and low poverty neighborhoods and among both privately- and publicly-insured patients. Notably profound declines in both deceased and living donor graft survival rates for black, compared to white and Hispanic, children preceded the 3-year mark when transplant Medicare eligibility ends. Further research is needed to identify the unique barriers to long-term graft success among black pediatric transplant recipients.

End-stage renal disease in Japanese children: a nationwide survey during 2006-2011.

End-stage renal disease (ESRD) in children is considered a rare, but serious condition. Epidemiological and demographic information on pediatric ESRD patients around the world is important to better understand this disease and to improve patient care. The Japanese Society for Pediatric Nephrology (JSPN) reported epidemiological and demographic data in 1998. Since then, however, there has been no nationwide survey on Japanese children with ESRD. The JSPN conducted a cross-sectional nationwide survey in 2012 to update information on the incidence, primary renal disease, initial treatment modalities, and survival in pediatric Japanese patients with ESRD aged less than 20 years during the period 2006-2011. The average incidence of ESRD was 4.0 per million age-related population. Congenital anomalies of the kidney and urinary tract were the most common cause of ESRD, present in 39.8 % of these patients. In addition, 12.2 % had focal segmental glomerulosclerosis and 5.9 % had glomerulonephritis. Initial treatment modalities in patients who commenced renal replacement therapy (RRT) consisted of peritoneal dialysis, hemodialysis, and pre-emptive transplantation (Tx) in 61.7, 16.0, and 22.3 %, respectively. The Japanese RRT mortality rate was 18.2 deaths per 1000 person-years of observation. The incidence of ESRD is lower in Japanese children than in children of other high-income countries. Since 1998, notably, there has been a marked increase in pre-emptive Tx as an initial treatment modality for Japanese children with ESRD.

Acute kidney injury and mortality in critically ill children

Background Mortality from acute kidney injury (AKI) can be ashigh as 60% in critically ill children. This high mortality rate isinfluenced by the severity of primary diseases, organ dysfunction,and the stage of acute kidney injury.Objective To assess for an as sedation between AKI and mortalityin critically ill children hospitalized in the pediatric intensive careunit (PICU).Methods A cross-sectional study was conducted from Aprilto July 2012. All patients aged 1 month to 18 years who werehospitalized in the PICU for more than 24 hours were included.Urine output and serum creatinine levels were evaluated daily.Patients were categorized according to the pediatric risk, injury,failure, loss, and end stage renal disease (pRIFLE) criteria. Chisquare, Fisher's exact, Mann-\X'hitney U, and Kruskal-Wallis testswere used to assess for an association between AKI, mortality,pediatric logistic organ dysfunction (PELOD) score, and lengthof PICU stay. AP value of &lt; 0.05 was considered as statisticallysignificant.Results During the study period, 57 children were admitted,consisting of 25 (43.9%) females and 32 (56.1 %) males, witha median age of 43 months. The prevalance of AKI was 31.5%(18/57) and classified into stages: risk 13/18, injury 3/18, andfailure 2/18. The mortality rate for AKI was 16. 7%. There was noassociation between AKI and mortality (P=0.592). The PELODscores were found to be similar among patients (SD 11.3 2 vs. SD12.23; P=0.830), and there was no association between AKI andlength of PICU stay (P=0.819).Conclusion There is no association between AKI and mortalityin critically ill children admitted in PICU.

Sustaining life or prolonging dying? Appropriate choice of conservative care for children in end-stage renal disease: an ethical framework.

Due to technological advances, an increasing number of infants and children are surviving with multi-organ system dysfunction, and some are reaching end-stage renal disease (ESRD). Many have quite limited life expectancies and may not be eligible for kidney transplantation but families request dialysis as alternative. In developed countries where resources are available there is often uncertainty by the medical team as to what should be done. After encountering several of these scenarios, we developed an ethical decision-making framework for the appropriate choice of conservative care or renal replacement therapy in infants and children with ESRD. The framework is a practical tool to help determine if the burdens of dialysis would outweigh the benefits for a particular patient and family. It is based on the four topics approach of medical considerations, quality-of-life determinants, patient and family preferences and contextual features tailored to pediatric ESRD. In this article we discuss the basis of the criteria, provide a practical framework to guide these difficult conversations, and illustrate use of the framework with a case example. While further research is needed, through this approach we hope to reduce the moral distress of care providers and staff as well as potential conflict with the family in these complex decision-making situations.

Selection of infants who potentially have congenital anomalies of the kidney and urinary tract from a large cohort for a more thorough examination.

Although congenital anomalies of the kidney and urinary tract (CAKUT) are the most common cause of pediatric end-stage renal disease (ESRD), little is known about the characteristics exhibited in the infantile period by CAKUT patients who develop ESRD. Further, an efficient screening method for CAKUT diagnosis is not available currently. In the present study, we aimed to develop a method to select infants who potentially have CAKUT from a large group of infants. We retrospectively investigated the clinical characteristics of CAKUT patients in the infantile period. The medical records of 101 patients with CAKUT who had undergone dialysis or renal transplantation were reviewed. The data of gestational age, birth weight, oligohydramnios, poor body weight gain, asphyxia, and jaundice were recorded. We attempted to determine the ideal characteristics that could be used to select infants who potentially have CAKUT. 14 % of patients were born prematurely, 18 % had low birth weight, 79 % had poor body weight gain, 18 % had asphyxia, 8 % had oligohydramnios, and 12 % had jaundice. We found that 82 % of patients had poor body weight gain or oligohydramnios among our patients and regarded these two symptoms as ideal markers for selecting those who potentially have CAKUT (specificity, 95 %; efficacy, 95 %). Further, the age of ≤ 7 months was the most appropriate time for the selection. For timely diagnosis of CAKUT, we recommend that ultrasound examination and the serum creatinine test be conducted for infants showing poor body weight gain or oligohydramnios at age ≤ 7 months.

High-resolution, whole-body vascular imaging with ferumoxytol as an alternative to gadolinium agents in a pediatric chronic kidney disease cohort

Exposure to gadolinium-based contrast agents (GBCA) in patients with chronic kidney disease (CKD) has been associated with the development of a potentially fatal disorder, nephrogenic systemic fibrosis (NSF). Although contrast-enhanced computed tomography (CT) is an alternative to magnetic resonance imaging (MRI), it carries the risk of radiation exposure and further reduction of residual renal function. Therefore we sought to assess the feasibility of ferumoxytol as an alternative to GBCA for contrast-enhanced MR angiography (MRA) in a pediatric cohort with CKD. Ferumoxytol is a parenteral iron supplement that contains ultrasmall superparamagnetic iron oxide (USPIO) and is a potent relaxivity agent for MRI. We describe the MRI findings in ten pediatric patients who needed detailed vascular mapping. Ferumoxytol (4mg/kg) was administered intravenously for contrast-enhanced MRA. The patients tolerated the procedure without complications. Resulting studies were highly diagnostic and were pivotal in guiding patient management. The images were notable for clear delineation of multiple vascular occlusions. Given the concerns associated with the use of GBCAs in renal failure, ferumoxytol is an excellent alternative contrast agent in pediatric end stage renal disease (ESRD) patients. Future studies are needed in order to further evaluate safety and efficacy of ferumoxytol in this patient population.

Design of the standardizing care to improve outcomes in pediatric end stage renal disease collaborative.

The Standardizing Care to Improve Outcomes in Pediatric End Stage Renal Disease (SCOPE) Collaborative is a North American multi-center quality transformation effort whose primary aim is to minimize exit-site infection and peritonitis rates among pediatric chronic peritoneal dialysis patients. The project, developed by the quality improvement faculty and staff at the Children's Hospital Association's Quality Transformation Network (QTN) and content experts in pediatric nephrology and pediatric infectious diseases, is modeled after the QTN's highly successful Pediatric Intensive Care Unit and Hematology-Oncology central line-associated blood-stream infection (CLABSI) Collaboratives. Like the Association's other QTN efforts, the SCOPE Collaborative is part of a broader effort to assist pediatric nephrology teams in learning about and using quality improvement methods to develop and implement evidence-based practices. In addition, the design of this project allows for targeted research that builds on high-quality, ongoing data collection. Finally, the project, while focused on reducing peritoneal dialysis catheter-associated infections, will also serve as a model for future pediatric nephrology projects that could further improve the quality of care provided to children with end stage renal disease.

Incidence of Thrombophilia in Autoimmune Versus Anatomic Causes of Pediatric End Stage Renal Disease Patients.

Incidence of Thrombophilia in Autoimmune Versus Anatomic Causes of Pediatric End Stage Renal Disease Patients.

Disparities in treatment rates of paediatric end-stage renal disease across Europe: insights from the ESPN/ERA-EDTA Registry

Disparities in treatment rates of paediatric end-stage renal disease across Europe: insights from the ESPN/ERA-EDTA Registry

201: Epidemiology of Acute Kidney Injury Following Cardiopulmonary Bypass in Pediatric Cardiac Surgery Patients

Acute kidney injury (AKI) is an important complication following cardiopulmonary bypass in pediatric cardiac surgery patients. However, its prevalence is highly variable in studies depending on the choice of AKI definition. Therefore, we aim to describe the epidemiology and outcome associated with AKI according to the accepted pediatric Risk Injury Failure Loss End-stage renal disease criteria (pRIFLE) in our postoperative population of pediatric cardiac surgery patients. Patients from zero to 18 years of age admitted to our PICU after cardiac surgery with cardiopulmonary bypass between May 2009 and May 2011 were included in this retrospective cohort study. Data were abstracted from the medical records and independently validated by two observers. Exclusion criteria were death during surgery, preoperative chronic kidney failure and prior heart transplant. Patients were classified according to the pRIFLE categories of risk, injury and failure before comparing their outcomes. Descriptive analyses were based on one-way analysis of variance F-test with correction for unequality of variances when appropriate. Of the 141 patients who met the inclusion criteria, 59 met the pRIFLE definition for AKI, representing a prevalence rate of 42%. Compared to the non-AKI group, AKI patients were younger (median 0.5 [IQR 0.01 to 1.41] vs 1.8 [IQR 0.72 to 8.07] years; P<0.0001), had higher Pediatric Risk of Mortality (PRISM) scores (median 10 [IQR 8 to 13] vs 8 [IQR 6 to 10]; P<0.05), higher maximal serum creatinine levels (mean 56 μmol/L [95% CI 48 μmol/L to 63 μmol/L] vs 37 μmol/L [95% CI 33 μmol/L to 40 μmol/L]; P<0.0001), longer intensive care unit length of stay (mean 129 h [95% CI 95 h to 163 h] vs 58 h [95% CI 40 h to 75 h]; P<0.05), longer mechanical ventilation duration (mean 57 h [95% CI 26 h to 89 h] vs 21 h [95% CI 5 h to 37 h]; P<0.05) and longer duration of cardiopulmonary bypass (mean 142 min [95% CI 125 min to 159 min] vs 95 min [95% CI 85 min to 106 min]; P>0.05). One patient in each group died. AKI is highly prevalent following cardiopulmonary bypass in pediatric cardiac surgery. Increasing severity of AKI is associated with longer duration of cardiopulmonary bypass, longer intensive care unit length of stay and duration of mechanical ventilation. Specific modifiable risk factors and therapeutic approaches for AKI still need to be identified in order to prevent and treat AKI in this specific population.

Recessive mutations in CAKUT and VACTERL association

Understanding the complex genetic makeup underlying congenital anomalies of the kidney and urinary tract (CAKUT) is of primary importance to improve diagnosis, stratify risk for later-onset complications, and develop therapeutic strategies. Saisawat et al. used homozygosity mapping coupled with next-generation sequencing to identify recessive mutations in TRAP1 in families with isolated CAKUT and with VACTERL association. This study points to a novel player in kidney development, possibly affecting apoptosis and endoplasmic reticulum stress signaling.

Long-Term Quality of Life and Social Outcome of Childhood End-Stage Renal Disease

To assess quality of life (QoL) and social status after 30 years of renal-replacement therapy (RRT) and to explore determinants of this QoL. The cohort comprised all Dutch patients, born before 1979, who started RRT at age<15 years in 1972-1992. All patients still alive in 2010 were asked to complete questionnaires on QoL (RAND-36) and sociodemographic outcomes. Scores were compared with those in the age-matched general population and with previous patient scores obtained in 2000. We performed logistic regression analysis for prediction of QoL outcomes. A total of 89 of 152 patients still alive in 2010 participated. Compared with the general population, QoL more often was impaired in patients receiving dialysis for most physical domains, in transplanted patients only on general health perception. Both transplanted and dialysis patients had normal or high scores on mental health. Scores in most physical domains were lower than in 2000. Patients were employed less often (61.8% vs 81.0%), had fewer offspring (31.5 vs 64.8%), and were less likely to have an income equal to or above average (34.8% vs 55.7%) compared with the general population. Disabilities, comorbidity, and unemployment were associated with impaired QoL. After 30 years of RRT, adult survivors of pediatric end-stage renal disease have an impaired physical but a good mental QoL. The decrease of general health perception and physical functioning over time is worrying and may further hamper employment status and social functioning of these relatively young patients.

Paediatric end-stage renal disease in a tertiary hospital in South West Nigeria

BackgroundChildren and adolescents with end-stage renal disease (ESRD) in sub-Saharan Africa may have the worst outcomes globally. Barriers to management include late presentation, poor socioeconomic conditions, absence of medical insurance, limited diagnostic facilities and non-availability of chronic renal replacement therapy (RRT). Our study was to determine the incidence, aetiology, management and outcomes of paediatric ESRD in a tertiary hospital in Nigeria.MethodsA retrospective case review of paediatric ESRD at the University College Hospital Ibadan, Nigeria, over 8 years, from January 2005 to December 2012.Results53 patients (56.6% male), median age 11 (inter quartile range 8.5-12) years were studied. Mean annual incidence of ESRD in Ibadan for children aged 14 years and below was 4 per million age related population (PMARP) while for those aged 5-14 years it was 6.0 PMARP. Glomerulonephritis was the cause in 41 (77.4%) patients amongst whom, 29 had chronic glomerulonephritis and 12 had nephrotic syndrome. Congenital anomalies of the kidneys and urinary tract (CAKUT) accounted for 11 (21.2%) cases, posterior urethral valves being the most common. Acute haemodialysis, acute peritoneal dialysis or a combination of these were performed in 33 (62.3%), 6 (11.3%) and 4 (7.5%) patients respectively. Median survival was 47 days and in-hospital mortality was 59%.ConclusionsIncidence of paediatric ESRD in Ibadan is higher than previous reports from sub-Saharan Africa. Glomerulonephritis, and then CAKUT are the most common causes. Mortality is high, primarily due to lack of resources. Preventive nephrology and chronic RRT programmes are urgently needed.

Pediatric renal transplantation: 5 years experience from Jaslok Hospital, Mumbai

ObjectivesTo evaluate the patient characteristics, complications and outcome of renal transplantation in pediatric end stage renal disease (ESRD). Type of studyRetrospective observational analysis. SubjectsChildren with ESRD subjected to renal transplantation in last 5 years (April 2007–March 2012) at Jaslok Hospital. MethodsDemographic data of the transplant recipients and donors, prior dialysis, surgical details of renal transplantation, immunosuppression, medical and surgical complications and post-transplant follow up and outcome was assessed. Results20 children in the age group 6–18 years (mean 14.6 years) underwent renal transplantation in last 5 years at our hospital. Fifteen percent cases (n = 3) weighed < 20 kg at transplantation. Primary cause of renal failure was glomerular in 30%, tubulo-interstitial in 45% and unknown in 25%. All were primary transplants, pre-emptive in 15%; live related in 95%, cadaveric in 5%. Mothers were the kidney donors in 60% cases. Induction therapy was used in 60% while maintenance therapy comprised of triple regimen. UTI was the commonest surgical complication (40%) followed by perinephric collection (20%), lymphocoele (15%) and renovascular thrombosis (10%, associated with graft dysfunction). 15% cases experienced graft rejection (acute cellular rejection (ACR), 66.6% and antibody mediated rejection (AMR), 33.3%) with complete renal recovery following treatment.73.4% and 72.8% cases had functioning grafts at the end of one and three years respectively. ConclusionsPediatric renal transplantation was associated with 100% patient survival and is a safe therapeutic option for children with ESRD.