Considerations for imaging of children pre-operatively- and in the early post-operative period of renal transplantation

Renal transplantation is the preferred treatment for children with end-stage renal failure, offering superior survival, growth, and quality of life compared with long-term dialysis. Up to 40% of paediatric renal transplants are performed for congenital abnormalities of the kidneys and urinary tract (CAKUT), contrasting with adult causes such as diabetes and hypertension. Paediatric transplantation presents unique challenges due to potential donor-recipient size variation, diverse underlying pathologies, and limited availability of standardized clinical and imaging protocols. This educational review outlines the radiologist's role in the multidisciplinary management of paediatric renal transplantation, emphasizing the pre-operative and early post-operative phases. Pre-operative imaging is essential to assess vascular anatomy, bladder function, and available abdominal space; to guide surgical planning; and to minimize complications. All pre-operative imaging must be tailored to individual clinical scenarios. Post-operative imaging is performed by ultrasound with Doppler evaluation to monitor graft perfusion, vascular integrity, collecting system drainage, and perinephric complications. Awareness of normal post-operative findings, technical pitfalls, and early complications is critical. Understanding the surgical approach and anastomotic configuration enhances accurate interpretation. This review advocates for harmonization of imaging strategies across centres, to improve diagnostic accuracy and long-term outcomes in paediatric renal transplantation.