Kidney transplantation in infants and small children

Transplantation is now the preferred treatment for children with end-stage kidney disease. But not all pediatric age groups have enjoyed the same success. The number of transplants in infants and young children has lagged behind the number in older children. One reason for this is the philosophy of some centers to maintain infants on dialysis until they reach some arbitrarily determined age, at which time they would undergo a transplant. If kidney transplantation is the therapy of choice for older children with renal failure, and equivalent results can be obtained in all age groups, why should it not be offered to these youngest patients? Our center's philosophy for many years has been not to restrict transplant based on size or age. We have performed over 50 kidney transplants in infant recipients, and have shown equivalent results to those obtained in older children. Important factors in obtaining a successful outcome include the use of adult kidneys from a living donor, careful attention to operative and perioperative care, and performing the transplant early or in a pre-emptive fashion. The latter allows for minimizing the negative impact of uremia on physical and neurologic development in infants.