Anna Grünewald, Thurid Ahlenstiel-Grunow, Zainab Arslan, Nina Battelino, Andreea-Liana Bot Rachisan, Antonia Bouts, Marco Busutti, Elisabeth Cornelissen, Huib de Jong, Jan Dudley, Ali Düzova, Fabian Eibensteiner, Alexander Fichtner, Svitlana Fomina, Mercedes López González, Bora Gulhan, Carl Grabitz, Julien Hogan, Britta Höcker, Stefanie Jeruschke, Nele Kanzelmeyer, Jon Jim Kim, Uwe Korst, Raffaela Labbadia, Mieczysław Litwin, Stephen Marks, Anette Melk, Gregor Novljan, Łukasz Obrycki, Jun Oh, Nils Pape, Andrea Pasini, Christian Patry, M. Pohl, Evgenia Preka, Agnieszka Prytula, Susanne Rieger, Mario Schiffer, Raphael Schild, Tomáš Seeman, Jelena Stojanović, Sara Testa, Burkhard Tönshoff, Diletta Domenica Torres, Lutz T. Weber, M Nothacker, Lars Pape
BACKGROUND: There is a lack of robust evidence regarding immunosuppressive therapy in children and adolescents after kidney transplantation (KTx), and as such, international practice is highly variable. Recent clinical practice recommendations advocating individualized immunosuppressive strategies that incorporate newer agents are often not implemented. This can potentially contribute to reduced patient and renal allograft survival. METHODS: The guideline was developed between January 1, 2024, and December 12, 2025, according to the Guidance Manual of the German Association of Scientific Medical Societies by the German Societies for Pediatric Nephrology, Nephrology, Transplantation, and Pediatrics, the German Kidney Association, the International Pediatric Transplant Association, the European Society for Pediatric Nephrology and the Members of the Cooperative European Pediatric Renal Transplant Initiative. RESULTS: This evidence- and consensus-based guideline provides up-to-date, state-of-the-art recommendations for immunosuppressive therapy after KTx in pediatric kidney transplant recipients. It is based on the best available evidence and the consensus of the relevant German Medical Societies, Members of the Cooperative European Paediatric Renal Transplant Initiative, and the working group on transplantation of the European Society for Paediatric Nephrology, and the International Pediatric Transplant Association. CONCLUSIONS: The formal consensus reached is particularly significant in cases of weak or inconclusive evidence and where recommendations are based solely on expert opinion.