During the past decade, as hemodialysis and renal transplantation have become more available, the outlook for children with irreversible renal insufficiency has changed dramatically. Prior to that time, no programs were devoted exclusively to the treatment of children with end-stage renal disease (ESRD), and a limited number of children received treatment in adult facilities. In light of very limited experience there were those who claimed1,2 that the rigors of the treatment program were so catastrophic for both child and family, and the outlook so dismal, that dialysis and transplantation should not be offered to children. Despite these warnings a program was initiated in 1967 at Childrens Hospital of Los Angeles (CHLA) to provide dialysis and transplantation for children with ESRD. The program was designed to include a component for long-term medical and psychosocial evaluation. Subsequently, other programs were developed in the United States, Canada, and western Europe. The latest report on Regular Dialysis and Transplantation of Children in Europe, 1975,3 of the European Dialysis and Transplant Association Registry included 1,111 children who were less than 15 years of age at the initiation of therapy, and the last report of the ACS/NIH Transplant Registry4 included data on 987 children, 0 to 15 years of age. In addition, numerous articles5-25 describing experience with transplantation in children attest to the increasing acceptance of this therapeutic modality for children. However, there are few reports of children surviving with a functioning graft for more than five years.13,14,21-23-25 Only the reports of DeShazo et al.21 and Weil et al.25 include data on the long-term results of renal transplantation in a large number of pediatric patients.