Kidney Transplantation as Modern Treatment for Children with Terminal Renal Failure
The number of children treated for terminal renal failure (TRF) has increased over the last decade. In spite of this, the incidence of newly discovered children and adolescents with CKD is much lower than in adults. In the past years, the results of kidney transplantation in children have been improving and are approaching those in adults. Improvement in transplantation results is a consequence of better knowledge of the factors affecting graft survival and progress in the field of immunosuppressive treatment. Kidney transplantation is now the method of choice for the treatment of children with CKD. As part of immunosuppressive treatment in recent years, induction treatment of children with antibodies is growing increasingly more popular. Research in the field of immunosuppressive treatment is focused primarily on replacing medications with significant adverse effects (steroids, cyclosporin). Patient noncompliance in taking the prescribed medicines is among important reasons for chronic transplant rejection, which is the most common reason for poor transplantation results in children and adolescents. Fear of cosmetic side effects of immunosuppressive treatment has a significant effect on patient compliance and is most pronounced in adolescent girls. Care for appropriate growth is one of priority tasks in the management of children and adolescents with terminal renal failure. New steroid-free immunosuppressive protocols could improve growth after renal transplantation. Modern immunosuppressive treatment has significantly reduced the number of acute rejection reactions. At the same time, the number of viral and bacterial infections following transplantation has increased. Infections are the most commonly stated causes of death in children with transplanted kidneys. In adolescents and young adults who have had chronic kidney disease since childhood, the main complications are cardiovascular diseases. Therefore, attention must be paid to possible risk factors even after transplantation and these should be treated consistently.