Renal transplantation (RTx) is the preferred method for the treatment of children in end stage renal failure. This is a retrospective analysis of the results of RTx in children at our centre. 528 RTx procedures have been performed in Kuwait since November 1993. 69 procedures (13%) were in children. Paediatric recipients were 41 males and 38 females aged 2.5 to 18 years [mean age 14 years]. The cause of renal failure was chronic pyelonephritis in 25, interstitial nephritis in 9, chronic glomerulonephritis in 6, focal segmental glomerulosclerosis in 6, and other causes in the remaining 23 recipients. Kidney grafts were obtained from 39 living and 30 cadaveric donors. The procedure was a primary transplantation in 60, and a re-transplantation in 9 recipients. Abnormal lower urinary tract was found in 32 recipients (46.6%). Induction immunosuppression in immunologically high-risk patients was with either ATG or Simulect. 19 (27%) instances of post RTx surgical complications were diagnosed. They were: renal vessel thrombosis in 4, renal artery stenosis in 1, lymphocele and wound haematoma in 10, and urological complications in 4 recipients. 16 episodes of acute rejection (23%) were detected and resulted in no graft loss. One recipient died with functioning graft at 21 months, and eight more grafts were lost one day to 87 months after RTx. The recipient actuarial survival rates were 100% and 98.6% at 1 and 5-year respectively. The 1 & 5 year actuarial graft survival rates were 97% & 97% respectively in living donor transplantation, and 83% &73% respectively in cadaveric donor transplantation. All paediatric recipients with functioning grafts are fully rehabilitated. They are either back to school or started employment. In conclusion, RTx is the preferable modality of treatment for children in end stage renal failure. Recipients of living donor grafts have a higher rate of graft survival compared to those of cadaveric donor grafts.