Renal transplantation (RTx) is the preferred method for the treatment of children in end stage renal failure (ESRD). This is a retrospective analysis of the results of RTx in children at our centre. Since November 1993, 86 children (50 males and 36 females) had received RTx from 50 living (LDTx) and 36 cadaveric donors (CDTx). Twenty children were <10 years. Some patients had –beside ESRDone or more other high risk factors, e.g. abnormal lower urinary tract in 36 recipients (42%). The procedure was a pre-emptive transplantation in 28, and a re-transplantation in 9 recipients. Induction immunosuppression was with either antithymocyte globulin (43 cases) or anti-interleukin-2 receptor antibodies (20 cases). Patients were followed up for 3 to146 Months. 24 instances of surgical complications were diagnosed in 19 (28%) recipients. These were in the form of 6 vascular, 4 urological, 1 wound dehiscence and 13 complications related to kidney bed. Twenty-four episodes of acute rejection (33%) and 17 episodes of systemic bacterial and viral infection were detected. Two recipients died at 1 and 21 months, and a total number of 14 grafts were lost at one day to 87 months after RTx. The 1- and 10-year actuarial survival rates were 99% and 98% respectively for recipient, and 88% and 84% respectively for grafts. The 10-year actuarial graft survival rates were 98% in LDTx, and 64% in CDTx, 86% in recipients >10 years old, and 75% in recipients <10 years old. Abnormal urinary tract, pre-transplant dialysis and transplant number showed no effect on graft survival. All pediatric recipients with functioning grafts are fully rehabilitated. In conclusion, RTx is the preferable modality of treatment for children in end stage renal failure. Higher graft survival rates were achieved in older children and following LDTx.