Pediatr Nephrol (2009) 24:475–484 DOI 10.1007/s00467-007-0559-2 EDUCATIONAL FEATURE Long-term outcome after renal transplantation in childhood Lesley Rees Received: 11 May 2007 / Revised: 19 June 2007 / Accepted: 19 June 2007 / Published online: 9 August 2007 # IPNA 2007 Abstract and learning objectives: The purpose of this article is to review: 1. Factors influencing long-term outcome data after transplantation 2. Patient survival overall, the effect of recipient age and donor type, causes of death, comparison of mortality after transplantation with that on dialysis, and effect of pre-emptive transplantation and race 3. Transplant survival overall, and the effect of recipient and donor age, donor type, pre-emptive transplantation, recurrent diseases, human leukocyte antigen (HLA) matching, immunosuppression, concordance, hyperten- sion, bladder dynamics and type of donor nephrectomy 4. Final height and obesity 5. Psycho-social outcome Keywords Long-term outcome . Mortality . Graft survival . Growth . Psycho-social L. Rees Department of Nephrology, Great Ormond Street Hospital for Children NHS Trust, London, UK L. Rees (*) Department of Nephrourology, Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London WC1N 3JH, UK e-mail: L.Rees@ich.ucl.ac.uk Introduction The first paediatric renal transplantations took place in the 1970s. During the 1980s there was a steady increase in num- bers, and there has been relative stabilisation since 2000, such that now most registries report that approximately two-thirds of children and adolescents on end-stage renal failure (ESRF) programmes have a transplant [1–4]. Studies of outcome over 20 years are now beginning to emerge [1, 5–9]. Such information is of considerable importance in order for us to counsel patients and families. However, we have to remember that we cannot assume to be able to extrapolate directly from these data to the current day. This is because changes over the years have had both positive and negative influences: ad- vances in technical and therapeutic knowledge and the increasing numbers of families that are coming forward for living donation (LD) have to be balanced against the accep- tance of more and more challenging patients onto ESRF programmes, including neonates and children with severe, and sometimes life threatening, co-morbidity [10]. What is consis- tently demonstrated is that there has been an improvement in outcome over the years [1, 11–13]. Clearly, it is rather artificial for us to consider long-term outcome only in patients with transplants, as most will switch treatment modalities over such a time span. Still, such data are important in order to provide comparative results between dialysis and transplantation, information which will influence management decisions. Factors influencing outcome data Long-term outcome data will be affected by several factors. Available resources [7, 14] affect patient selection, follow- up and drug regimens. Community attitudes influence