Paediatric renal transplantation: Paediatric surgeons' perspective

Abstract Renal transplantation is the most effective treatment for paediatric end‐stage renal disease (ESRD), offering advantages in survival, growth and neurocognitive development that surpass other renal replacement therapies (RRT). The paediatric setting, however, introduces distinct complexities that distinguish it from adult practice. One of the most significant challenges is the size mismatch between the small recipient and the adult donor kidney, which can lead to technical and surgical complications such as vascular anastomoses, thrombosis and ureteral leaks. This review aims to examine the spectrum of unique factors influencing transplant outcomes, including paediatric‐specific ESRD aetiology, pre‐operative urodynamic investigation and dialysis planning, intra‐operative surgical and haemodynamic considerations, and post‐operative management. Current evidence highlights the need for multidisciplinary teams with specialised paediatric expertise. By tailoring surgical approaches and long‐term management to the physiology and developmental needs of children, paediatric transplant teams can maximise graft survival, minimise morbidity and enhance long‐term quality of life in this vulnerable population.