From 1968 to 1978, 66 renal transplants were performed on 58 pediatric patients with end stage renal failure. With a mean followup of 6 years 46 patients (79.3 per cent) are alive and 35 (60.3 per cent) currently have a functioning renal allograft. Live donor allografts yielded fewer surgical complications and better long-term functional survival rates than cadaver allografts. Patient rehabilitation following a successful renal transplant was excellent. However, despite resumption of growth in most cases normal linear growth was achieved rarely. Renal transplantation provides the best long-term solution to the problem of end stage renal disease in children.