title: Long-term effects of paediatric kidney transplantation.
abstract: Renal transplantation in paediatric patients usually provides excellent short-term and medium-term results. Early diagnosis of chronic kidney disease and active therapy of end-stage renal disease before and after transplantation enables the majority of children to grow and develop normally. The adverse effects of immunosuppressive medication and reduced graft function might, however, hamper long-term outcomes in these patients and can lead to metabolic complications, cardiovascular disease, reduced bone health, and malignancies. The neurocognitive development and quality of life of paediatric transplant recipients largely depend on the primary diagnosis and on graft function. Poor adherence to immunosuppression is an important risk factor for graft loss in adolescents, and controlled transition to adult care is of utmost importance to ensure a continued normal life. In this Review, we discuss the outcomes and long-term effects of renal transplantation in paediatric recipients, including consequences on growth, development, bone, metabolic, and cardiovascular disorders. We discuss the key problems in the care of paediatric renal transplant recipients and the remaining challenges that should be the focus of future research.
authors.affiliation: Department of Paediatric Nephrology &Transplantation, Children's Hospital, University of Helsinki and Helsinki University Central Hospital, Stenbäckinkatu 11, PO BOX 281, Helsinki, FI-00290, Finland.
authors.forename: Christer
authors.initials: C
authors.lastname: Holmberg
authors.affiliation: Department of Paediatric Nephrology &Transplantation, Children's Hospital, University of Helsinki and Helsinki University Central Hospital, Stenbäckinkatu 11, PO BOX 281, Helsinki, FI-00290, Finland.
authors.forename: Hannu
authors.initials: H
authors.lastname: Jalanko
mesh_terms: D000367:Age Factors; D015519:Bone Density; D002648:Child; D002657:Child Development; D003071:Cognition; D006085:Graft Survival; D019382:Human Growth Hormone / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000628:therapy; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000401:mortality / Q000523:psychology; D008232:Lymphoproliferative Disorders / Q000209:etiology; D008659:Metabolic Diseases / Q000209:etiology
chemical_list: D007166:Immunosuppressive Agents; D019382:Human Growth Hormone