Outcomes after pediatric kidney transplantation improving: how can we do even better?

Kidney transplant is the treatment of choice for children and adolescents with end-stage renal disease because transplantation improves quality of life and survival to a far greater extent than chronic dialysis. Unfortunately, however, transplantation does not completely normalize the excess risks associated with end-stage renal disease nor do transplanted allografts function indefinitely. In this issue of Pediatrics, Van Arendonk et al provide valuable information on national trends in outcomes among pediatric kidney transplant recipients. Over a 25-year period, the authors observed remarkable improvements in patient and allograft survival following kidney transplantation after accounting for many changes in donor and recipient characteristics. The greatest improvements for both patient and allograft survival were within the first year, highlighting the need for ongoing improvements in long-term outcomes.