Pediatr Nephrol (2009) 24:475–484 study: motor, hearing, or visual disabilities were found in 19%. Bone disease, headaches, itching, and tremors were the most reported disabling problems [8]. Other complica- tions included osteoporosis in 53% of patients, avascular bone necrosis in 13%, post-transplantation diabetes mellitus in 10%, and hypertension in 60% [82]. In the study from Norway, minor cataracts without visual disturbance were found in 45% of patients [9]. Sensorineural hearing loss was documented in 18% of patients receiving transplants before the age of 5 years in Finland, and 15% received anti- convulsive treatment after transplantation [83]. In Germany, 27% suffered from additional disabilities [6]. In the USA, health-related absence from work was non-existent for 93%. Health was rated as good to excellent by 91% and fair by 9%. The future was regarded as hopeful or promising by 80% [81]. Education In the French study the distribution of educational level was lower than national averages: 27.4% were at the lowest level versus 3% of the general population, 41.4% were at the middle level, 31.2% had reached the bac- calaureate level, and 11% had followed a university course [75]. Compared with that of all age-matched Dutch inhabitants, educational attainment was low [8]. In Finland, 79% of children who had undergone transplantation before the age of 5 years attended ordinary schools and 76% had normal motor performance. The mean intelligence quotient (IQ) was 87, and 6–24% showed impairment in neuropsy- chological tests [83]. Patients’ scores on achievement tests were influenced by age at diagnosis and by the mother/ caregiver’s lower achievement [84]. Independence In the French study, 46% lived in their parents’ home and 54% lived independently. There was a correlation between educational level, paid activity, marital life, and indepen- dent housing with final height [75]. Rates of dependency on parents were also high in the Dutch study [8]. Conclusion Transplantation is the treatment of choice for children with ESRF. It offers the best chances for growth, development and quality of life, and is associated with a lower mortality risk than is dialysis, particularly that due to CVD. For these reasons, many paediatric nephrologists aim for pre-emptive transplantation for their patients, and more and more families are coming forward as potential LDs for their children. 481 Questions (answers appear after references) For each question (a) to (e), answer true or false 1. Factors that positively influence long-term outcome: (a) Analysis of cohorts since the 1980s in comparison to before that (b) Non-Caucasian race (c) Proportion of LDs (d) Co-morbidity (e) A high proportion of adolescents 2. Patient survival: (a) LD is of particular benefit to those under 2 years of age (b) Deaths occur much later after transplantation in those who received transplants before they were 5 years of age than after this age (c) Cause of death is most commonly malignancy (d) The incidence of infections as a cause of death is increasing (e) Is adversely affected by obesity 3. Cardiovascular disease (a) Is the commonest cause of death after transplantation (b) Has a lower incidence in dialysis patients than in post-transplantation patients (c) Is a more common cause of death in Afro- Americans than in the white population (d) Hypertension is uncommon after transplantation (e) Is likely to become more common, given the increasing incidence of obesity after transplantation 4. Transplant survival (a) Is much worse in very young children, according to the latest data (b) Recurrence of FSGS has a worse prognosis in adolescents than in younger children (c) LD transplant survival is superior to DD transplant survival in the first 5 years after transplantation (d) Is superior in pre-emptive transplants in adolescents (e) Is unaffected by HLA matching 5. Psychosocial and other factors (a) There is no evidence for improving height prog- nosis over the years (b) Laparoscopic donor nephrectomy has a negative effect on graft outcome (c) Bone disease is the commonest cause of post- transplantation morbidity (d) Most studies have not shown an adverse effect of abnormal bladder dynamics on outcome (e) Generally, reports of psychosocial outcomes are disappointing