Pediatric Kidney Transplantation: A Systematic Review.

BACKGROUND/OBJECTIVES: Kidney transplantation is the most effective treatment for pediatric patients with end-stage renal disease (ESRD), offering superior survival rates and quality of life compared to dialysis. However, long-term graft survival remains a complex clinical and surgical challenge. This systematic review aims to evaluate short- and long-term graft outcomes and comprehensively analyze the primary clinical, immunological, and procedural risk factors driving pediatric graft failure. METHODS: A comprehensive search was conducted across the PubMed database, yielding 289 initial records. Following duplicate removal and systematic title and abstract screening, 108 full-text articles were evaluated for eligibility. Ultimately, 35 high-quality studies met the full inclusion criteria and were selected for final data synthesis and analysis. RESULTS: Synthesized data revealed high short-term outcomes, with a 1-year graft survival rate of 94.60%. However, survival experienced a steady decline over time, dropping to 59.50% at the 10-year mark. Acute rejection episodes and delayed graft function (DGF) were identified as the primary immunological primary risk factors. Furthermore, specific donor characteristics, early surgical complications (such as vascular thrombosis), post-transplant infections affecting nearly 45% of patients, and adolescent non-adherence to immunosuppressive regimens were heavily associated with accelerated graft failure. CONCLUSIONS: While short-term success in pediatric kidney transplantation is highly encouraging, long-term graft longevity requires targeted clinical interventions. Optimizing outcomes necessitates precise, lifelong management strategies specifically focused on mitigating chronic rejection, preventing post-operative infections, and implementing multidisciplinary support systems to enhance patient adherence to immunosuppressive therapy.