Complications of paediatric kidney transplantation: a paediatrician's review.

Abstract

Kidney transplantation is the preferred treatment for children with end-stage kidney disease, offering notable improvements in long-term survival and overall quality of life. Nonetheless, paediatric transplant recipients are susceptible to a spectrum of complications that compromise allograft function and overall health. This review highlights key post-transplant complications to aid general paediatricians in recognising and managing these challenges in concert with nephrologists. Early post-transplant complications include surgical issues and electrolyte abnormalities. Infectious complications are most frequent during the first year post-transplant and include viruses such as cytomegalovirus, Epstein-Barr virus and BK virus, as well as urinary tract infections and <i>Pneumocystis jirovecii</i> pneumonia. These infections are largely related to the degree of immunosuppression and require close monitoring. Cardiovascular and metabolic conditions, including hypertension, hyperlipidaemia and post-transplant diabetes mellitus, are also prevalent and contribute to long-term morbidity. These issues often stem from pre-existing kidney disease and ongoing immunosuppressive therapy. Allograft rejection, whether antibody-mediated or T cell-mediated, continues to be a major threat to graft survival. Early detection through donor-specific antibody screening and timely biopsy is essential for prompt intervention. Additional challenges include increased cancer risk, particularly post-transplant lymphoproliferative disorder, and recurrence of primary kidney disease. By recognising these complications early, general paediatricians play a crucial role in multidisciplinary care, improving graft survival and patient outcomes.