Long-term complications of renal transplantation.

Excellent survival data and rewarding rehabilitation have been reported following kidney transplantation. Annual mortality decreases with time after transplantation and has dropped below 2% in children and below 3% in young adults. No major single cause of death has been identified. Short-term graft survival rates are still improving but no major breakthrough in long-term graft maintenance has been achieved. The major cause of graft failure is chronic rejection. Major causes of morbidity in long-term graft recipients are: hypertension occurring in 65-75% of the recipients, avascular necrosis of the bone resulting in severe disabling in 4% of transplant recipients and growth retardation. Also, in patients receiving a kidney transplant during childhood, an increased risk of de novo malignancy development was reported. Full rehabilitation is often hampered by physical disabilities and will restrict social life. However, the possibility of obtaining employment is not different from that of the general population. The evaluation of morbidity in long-term kidney transplant survivors requires the collaboration of larger pediatric transplantation centers.