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Background and Objective: Cytomegalovirus (CMV) infections are associated with severe morbidity and mortality in patients, especially pediatric renal transplantation patients. The use of immunosuppressive agents places these patients at the risk of viral infections. As cytomegalovirus infection influences the graft outcome, adopting useful strategies for limiting this virus after transplantation seems necessary.

Methods: This systematic review evaluates all articles about the prophylactic treatment in pediatric renal graft recipients.

Results: There are several anti-viral agents that are used alone or in combination for preventing CMV infection. The prophylactic agents that are used in pediatric recipients include CMV-Ig, IVIG, acyclovir/valacyclovir, and ganciclovir/valganciclovir. CMV-Ig is an adjective agent and it is less effective if used alone.  Although performed studies in children are not sufficient to determine valacyclovir effect in preventing reactivation of cytomegalovirus, valacyclovir is used in moderate risk recipients for CMV infection. It seems that valacyclovir is less effective than valganciclovir.

Conclusion: Nowadays oral valganciclovir is the most appropriate prophylactic agent used in most transplant centers for children and adults.  However it appears that valganciclovir prevents cytomegalovirus infection only during prophylaxis period. The incidence of late CMV infection does not reduce by this drug. Some trials in adults and a retrospective study in children recommend that longer duration of prophylaxis with valganciclovir lowers the incidence of CMV infection in late stage.

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Kidney Transplantation in children is the treatment of choice to treat end stage renal disease. Improvements in immunosuppressive management have dramatically reduced the risk of early acute rejection and graft loss, however the long term results in terms of graft survival and morbidity still require search for new immunosuppressive regimens. Reducing of side effects are the challenges for improving the outcome of pediatric transplantation. This review will discuss the current trends and outcomes of the kidney transplantation in children.

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Background and Objective: Cystinosis is a rare inherited disease that leads to renal failure. Fanconi syndrome is the major renal involvement in cystinosis patients. Renal transplantation is the treatment of choice in cystinosis children with end-stage renal disease (ESRD).  The study aimed to assess the outcome of renal transplantation in Iranian children with cystinosis.

Methods: This retrospective study is a follow up of 21 cystinosis children transplanted in Labafinejad Hospital, Tehran, Iran.

Results: Three cystinosis patients involved by primary non-function because of graft vein thrombosis and/or severe acute tubular necrosis. The remaining cystinosis patients had excellent graft survival rate and only one patient lost the graft 3 years post-transplant due to noncompliance. The graft survival rate after excluding the patients with primary non-function was 100%, 94%, 94% and 94% at 1,3,5 and 10 years after transplant. The mean serum creatinine in patients with functioning graft 10 years after transplant was 1.6 mg/dl.

Conclusion: We showed that cystinosis patients had good graft function in long term after transplantation.

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Background and Objective: Some neurologic complications may be detected after renal transplantation in children including tremor, peripheral neuropathy, altered level of consciousness and seizure. The aim of our study was to detect the prevalence of seizure after renal transplantation and its risk factors in pediatric age groups.

Methods: In this descriptive study, 102 patients 5-14 year old in Ali-Asghar children’s hospital with renal transplantation were enrolled from December 2011 to December 2013. Data about age, gender, primary renal diseases, seizure type, history of previous seizure, and causes of seizure were analyzed through SPSS v.18.

Results: Mean (SD) age was 11.69±2.52 years. Fifty seven cases (57.8%) were male. Twelve (11.8%) cases had seizures. Mean age of seizure group was lower than group without seizure (P= 0.001). Causes of seizures were hypertension in 7(58%), febrile seizure in 3(25%), meningoencephalitis in 1(8.5%) and subdural hematoma in one patient (8.5%). Eleven (91.7%) patients had generalized seizure. Seven (6.9%) of all patients had history of previous seizures and 6(86%) were in seizure group (p=0.000). Four cases died and 2(50%) were in seizure group (P= 0.01).There was no significant relationship between gender, primary renal disease, and seizure occurrence after transplantation.

Conclusion: In our study, hypertension was common cause of seizure disorder after renal transplantation. Seizures were higher in patients with lower age at   transplantation time and with seizure history before transplantation. It is recommended to have more attention prior renal transplantation with neurology consultation and particular management of hypertension after renal transplantation

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Liver transplantation is the treatment of choice for children with end-stage liver disease.  Improvement in outcomes (allograft and patient survival) has led to widespread use of pediatric LT worldwide. This success is due to improvement in patient selection, transplant surgery, anesthesia/postoperative care and immunosuppression management. This review will focus on different aspects of LT which every pediatrician should know to provide better patient care.