ABSTRACT
Renal transplantation is the treatment of choice for children with end-stage renal disease as it offers the best prospect for health, growth, and development. A curvilinear incision is made, starting at the midline approximately one finger-breadth superior to the pubic symphysis, extending laterally across the rectus abdominis muscle, and then curving superiorly to about the level of the umbilicus. Particular attention needs to be focused on the length of the renal vessels and their orientation, considering the ultimate position of the kidney after it is perfused, the retractor is removed, and the fascia are closed. The authors routinely place a double-J stent after the anastomosis is partially completed, with the upper end positioned in the renal pelvis and the lower end passed into the bladder. Infants and small children are managed in a pediatric intensive care unit. Over the last decade, the introduction of several new agents has permitted several protocol permutations.
