​Introduction​​: Pediatric kidney transplantation is a critical treatment for end-stage renal disease (ESRD), yet clinical management remains challenging. This study retrospectively analyzed clinical outcomes and complications in pediatric recipients to optimize transplantation strategies.​
Methods​​: Clinical data from children (<18 years) undergoing kidney transplantation at the First Affiliated Hospital of Zhengzhou University (July 2007–December 2024) were reviewed. Donor and recipient profiles, perioperative complications, graft/recipient survival, and renal function recovery were analyzed.
​​Results​​: A total of 710 children were enrolled. The cohort included a male-to-female ratio of 1.78:1. Glomerulopathy (50%) was the most common primary disease, with a genetic diagnosis rate of 46.7%. Recipient/graft survival rates at 1, 3, and 5 years were 99.1%/96.9%, 98.5%/95.8%, and 98.0%/94.9%, respectively.

Serum creatinine decreased from 816.1 ± 303.1 μmol/L preoperatively to 62.7 ± 20.6 μmol/L at 3 months post-transplant. Estimated glomerular filtration rates (eGFR) at 1, 3, and 5 years were 166.8 ± 37.3, 135.1 ± 29.0, and 109.9 ± 31.1 mL/min/1.73 m², respectively. Surgical complications occurred in 10.5% of cases, predominantly transplant renal artery stenosis (2.5%). Delayed graft function (DGF, 30%), acute rejection (11%), and severe infections (36%, primarily pulmonary) were common medical complications. Recurrence of primary disease was observed in 16.7% of nephrotic syndrome/FSGS cases. Catch-up growth occurred in 55.1% of recipients within 1 year, most notably in preschool-aged children.
​​Conclusion​​: Pediatric kidney transplantation demonstrates excellent mid-to-long-term survival and renal function recovery. However, complications such as DGF, infections, and rejection necessitate vigilant management. Individualized strategies should address primary disease recurrence and growth promotion, particularly in younger recipients.