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Relative contraindications include active autoimmune disease, ABO incompatibility, and mental retardation. Certain diseases (i.e., membranoproliferative glomerulonephritis, focal sclerosing glomerulonephritis, HUS, HSP, and oxalosis) are known to recur in the allograft and may influence the timing of transplant, posttransplant management, and donor source. These issues should be discussed with the family pretransplant. Recipient weight is also a consideration. The smallest infant successfully transplanted was 5 kilograms.

Once the child has successfully completed the evaluation process, living donation is offered to the family. Potential donors have blood drawn for ABO typing, HLA typing, and crossmatch. Like recipients, potential donors are evaluated by a multidiciplinary team of internists, nephrologists, surgeons, psychologists, and social workers. The evaluation is aimed at uncovering hypertension, infection, malignancy, renal disease, and motivation for donation. Recipients without a living donor (LD) are placed on the cadaveric waiting list. USRDS data show that overall, 37% of children are transplanted within the first year of ESRD.1

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