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Complications of renal transplantation in children

Ruth A McDonald, MD
Section Editor
Patrick Niaudet, MD
Deputy Editor
Melanie S Kim, MD


Once the estimated glomerular filtration rate declines to less than 30 mL/min per 1.73 m2 (stage 4 chronic kidney disease), it is time to start preparing the child and the family for renal replacement therapy [1]. Although there have been many advances in conservative renal replacement therapy, renal transplantation is the best treatment for children with end-stage renal disease (ESRD) [2]. This was shown in a study from Australia and New Zealand, in which the risk for death was more than four times higher in children with ESRD treated with dialysis rather than renal transplantation [2]. Improvements in the care of young patients and advances in immunosuppressive therapy have also increased renal allograft and patient survival. Particularly, reduction in the frequency and severity of acute rejection has enhanced allograft survival [3].

This topic will provide an overview of the complications of renal transplantation in children. Some complications of renal transplantation are unique to children, while others are observed in all transplant recipients. Additional issues concerning transplantation in children and issues in renal transplantation common to both children and adults are presented elsewhere. (See "General principles of renal transplantation in children" and "Outcomes of renal transplantation in children".)


The causes of renal allograft dysfunction vary with the time after transplantation. These time periods are usually classified as immediate (zero to one week postsurgery), early (1 to 12 weeks postsurgery), late acute (after three months), and late chronic (years). (See "Differential diagnosis of renal allograft dysfunction".)

Causes of delayed graft function (immediate renal failure persisting after transplantation) include postischemic acute kidney injury, vascular thrombosis of the renal artery or vein, urologic complications (ie, urinary leak or obstruction), and rarely, hyperacute rejection.

Among patients with initial graft function who develop early renal insufficiency (ie, 1 to 12 weeks post-transplantation), the major causes of graft dysfunction are acute allograft rejection, calcineurin inhibitor toxicity, urinary obstruction, infection, hypovolemia, and recurrent disease.


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Literature review current through: Sep 2016. | This topic last updated: Jun 30, 2016.
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