title: Overview of a paediatric renal transplant programme.
abstract: BACKGROUND
  Renal transplantation is the therapy of choice for children with end-stage renal failure. There are many challenges associated with a paediatric programme in a developing country where organs are limited.
  
  
  METHODS
  A retrospective review was undertaken of 149 paediatric renal transplants performed between 1968 and 2006 with specific emphasis on transplants performed in the last 10 years. Survival of patients and grafts was analysed and specific problems related to drugs and infections were reviewed.
  
  
  RESULTS
  On review of the total programme, 60% of the transplants have been performed in the last 10 years, with satisfactory overall patient and graft survival for the first 8 years post transplant. At this point, transfer to adult units with non-compliance becomes a significant problem. Rejection is less of a problem than previously but infection is now a bigger issue--specifically tuberculosis (TB), cytomegalovirus (CMV) and Epstein-Barr virus (EBV) infections with related complications. A wide variety of drugs are available for tailoring immunosuppression to minimise side-effects.
  
  
  CONCLUSIONS
  It is possible to have a successful paediatric transplant programme in a developing country. However, to improve long-term outcomes certain issues need to be addressed, including reduction of nephrotoxic drugs and cardiovascular risk factors and providing successful adolescent to adult unit transition.
authors.affiliation: Department of Paediatric Nephrology, Red Cross War Memorial Children's Hospital, Rondebosch, Cape Town, South Africa.
authors.forename: M I
authors.initials: MI
authors.lastname: McCulloch
authors.forename: P
authors.initials: P
authors.lastname: Gajjar
authors.forename: C W N
authors.initials: CW
authors.lastname: Spearman
authors.forename: H
authors.initials: H
authors.lastname: Burger
authors.forename: P
authors.initials: P
authors.lastname: Sinclair
authors.forename: L
authors.initials: L
authors.lastname: Savage
authors.forename: C
authors.initials: C
authors.lastname: Morrison
authors.forename: C
authors.initials: C
authors.lastname: Davies
authors.forename: G
authors.initials: G
authors.lastname: van Dugteren
authors.forename: D
authors.initials: D
authors.lastname: Maytham
authors.forename: J
authors.initials: J
authors.lastname: Wiggelinkhuizen
authors.forename: M
authors.initials: M
authors.lastname: Pascoe
authors.forename: F
authors.initials: F
authors.lastname: McCurdie
authors.forename: A
authors.initials: A
authors.lastname: Pontin
authors.forename: E
authors.initials: E
authors.lastname: Muller
authors.forename: A
authors.initials: A
authors.lastname: Numanoglu
authors.forename: A J W
authors.initials: AJ
authors.lastname: Millar
authors.forename: H
authors.initials: H
authors.lastname: Rode
authors.forename: D
authors.initials: D
authors.lastname: Khan
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007676:Kidney Failure, Chronic / Q000601:surgery*; D016030:Kidney Transplantation; D008297:Male; D011183:Postoperative Complications; D015397:Program Evaluation / Q000639:trends*; D012189:Retrospective Studies