Background: In recent years transplant nephropathy has become the predominant cause of graft failure in children. Therefore, the new methods of prevention, diagnosis and therapy need to be critically evaluated. 

Methods: The methods include evaluation of long term graft function by Doppler ultrasonography, histological quantification of tubulointerstitial fibrosis, pharmocokinetic monitoring of immunosuppression, allocation of donor kidneys, and use of new immunosuppressive regimen.

Results: In a matched-pairs-analysis of the function of kidneys taken from adult donors was inferior to that of pediatric donor kidneys, thus showing the superiority of the "young for young" concept of organ donation. The quantification of fibrosis with PicroSiriusRed staining in renal biopsies correlated positively with the progression of graft failure revealing a new predictor of future graft function. Renal resistance indices >0.8 were identified as risk factors for loss of graft function. The advantages of C2-cyclosporin A level monitoring in comparison to conventional C0-monitoring was shown and C2 target levels were given. Basiliximab, an IL2-receptor-antagonist, had a positive effect on prevention of acute rejection episodes.

Conclusions: Long-term kidney transplant function and survival can be improved by a combination of well directed prophylaxis, early diagnosis and an individually tailored immunosuppressive therapy.

Key words: transplant nephropathy; kidney transplantation; chidren; prevention; therapy