480 Laparoscpic donor nephrectomy Laparoscopic donor nephrectomy is associated with a longer operation time and longer warm ischaemia and cold ischaemia times in LDs than is the open approach [71]. However, the number of hospitalisation days and the use of analgesia in laparoscopy donors are lower, and there are no differences in complications between the techniques. Most importantly, graft outcome does not seem to be affected [72]. Final height and incidence of obesity Final height is another factor that is influenced by the era of transplantation: improvements in pre-transplantation man- agement, particularly nutrition, have led to a better height attainment at transplantation, which is recognised as one of the most important factors in final height achievement [73]. Furthermore, the decline in steroid dosing as immu- nosuppression has also has a positive benefit on growth. Most studies report reduced final height in patients who underwent transplantation in childhood, with up to 44% below the normal range in early reports, improving to 25% more recently [6, 9]. Some studies include patients that have received recombinant human growth hormone (rHGH) and suggest that final height is better than for those not receiving it [74]. Median final heights for women and men, respectively, who did not receive rhGH, were 147.4 and 156.6 cm [75]. They were 151.0 cm [median standard deviation score (SDS) −1.9] and 162.7 cm (median SDS −1.8) in a study containing some patients on rhGH [76], and 156 cm and 165 cm in patients who all received rhGH [77]. However, one study reports good growth in children who did not receive growth hormone: a median height of 158 cm and 166 cm, respectively, for girls and boys older than 17 years, was reduced, in comparison with that of the general population, but it was within the nor- mal range, even though some patients had been treated with the higher doses of steroids used before ciclosporin was available. Many of the patients that had received transplants in the later years of the review period were still only 17 years old, so they may not have attained their final height [1]. Obesity, defined by a body mass index (BMI) >95th centile, is increasing in the transplant population (12.4% after 1995 and 8% before 1995) [36], and seems to be more common in girls [61]. Psychosocial outcome In spite of a high re-transplantation rate and the presence of significant morbidity, renal transplantation in children can lead to attainment of a productive and satisfying life, with a Pediatr Nephrol (2009) 24:475–484 high degree of rehabilitation in adulthood. It has to be remembered, however, that most studies are based on returns of questionnaires, which inevitably leads to selec- tion bias. Psychosocial outcome seems to be better after transplantation than for patients on dialysis [78]. Employment Several studies have revealed satisfactory employment levels, reported as follows: 81% employed [1]; 61.5% able to work, 43.4% working [79]; 86% employed [6]; 73% employed versus 72% in the general population, and 6.5% unemployed versus 10.5% in the general population, and 18.7% receiving a disablement pension [75]; 82% employed [33]; and 72% in paid work [80]. The range of occupations is broad, with a normal average working time each week; 91% were satisfied with their ability to perform at work or school, and only 5% were dissatisfied [81]. Relationships Successful relationships are reported in the majority of studies [80, 81] as follows: 50% married, and the overwhelming majority reported satisfaction in their sexual lives [33]; 50% of women and 27% of men married [72]; 67% of women and 25% of men married [1]; and 40% married, 27% had children [80]. The striking observation, however, was the very low incidence of men with children, both overall (7%) and in comparison with the women (24%), both in London [1], in the French study, when 8.3% of men had offspring in comparison to 27% of the women [75]. The cause of this finding is unclear. In the US study, 89% were satisfied with life in general, 95% said health never or seldom interfered with family life, and 95% felt that health and drug side effects were of no or minor concern in sexual relationships. Only 3% felt that health was a problem in maintaining a sexual relationship (41% were not sexually active). Only 4% stated that health often interfered with their social life; 98% met friends on a regular basis; 76% were satisfied with personal relation- ships, and 8% were dissatisfied [81]. Physical morbidity In a US study of those who had undergone transplantation between 1967 and 1999, nearly half were severely short and 27% were obese. Rates of hypertension, bone and joint symptoms, fractures, hypercholesterolaemia, and cataracts were high. In spite of significant remaining health issues, 95% reported their health as “fair” or “good”, 61% reported “no” or “minor” physical limitations, and 82% described themselves as “just as” or “more content than others” [33]. Co-morbidity was found in 40% of all patients in the Dutch