Renal transplantation in children: an American view from the bridge.

Performance of renal transplants in children frequently necessitates transfer of patients from the care of a local pediatric nephrologist to a regional, tertiary care center that is specially equipped to carry out organ transplantation. This shift in institutional affiliation can be the cause of some difficulties in treating these complicated patients including: (1) disparities in the expected outcome of the renal transplant procedure; (2) co-ordination and timely completion of the pre-operative evaluation; (3) proper handling of transfers of patients between medical centers and inter-physician communication; (4) psychosocial pressures encountered by parents when their children are under the care of two teams of physicians. It is recognized that the relationship between the referring pediatric nephrologist and the transplant physician is paradigmatic of the association that develops between a general practitioner and a specialist. With this in mind, we offer some tentative suggestions on how to improve the therapeutic alliance between referring pediatric nephrologists and transplant surgeons, in the hope that this will improve the care of all pediatric transplant recipients.