The management of end-stage renal disease, encompassing the principles of medical management, dialysis, and renal transplantation, formed the early experience with organ failure and replacement. The lessons learned were the basis for the exploding growth of solid organ replacement in children and adults. The care continuum for these patients can be divided into several phases: pretransplant medical management, transplantation, short- and long-term outcome. In this chapter, we will attempt to review the factors affecting success in medical pretransplant management, the transplant procedure, and throughout the short- and long-term follow-up periods. At each stage of care, factors which can determine the likelihood of success may be assigned (age, sex, ethnicity, primary disease, etc.). Some determinants of outcome are variable, that is, they are influenced by choices in care delivery (type of transplant, immunosuppression protocol, experience of transplant center, etc.). As the phases of transplantation are reviewed, we will attempt to identify avenues to improve outcome based on the application of current data.
Information reviewing the management of children with end-stage renal disease has been regularly evaluated and compiled in several large registries, allowing analysis of large cohorts. The United Network for Organ Sharing (UNOS)(www.unos.org) collects information on renal replacement in the United States, the United States Renal Data Systems (www.usrds.org) collects information regarding transplantation in Medicare patients.