*Purpose: Kidney transplantation for children suffering CKD5 has been established in Germany approximately 50 years ago. While in the early decades the focus was merely on patient and allograft survival, today we look at the quality of survival and the effects early-onset renal failure and transplantation may have.

*Methods: Our study addressed children and adolescents following kidney transplantation. In a cross-sectional design, we assessed quality of life, mental health, motor-development and selected cognitive functions using age-appropriate standardised instruments.

*Results: We included 53 patients age 0-18 (♂32 ♀21) age 0-18. Of these, 20 (37.7%) patients started dialyses before their 3^rd birthday. Mean time on dialysis was 499days (4-2690; sd 521); 17 children had pre-emptive transplantation. The average age at transplantation was 5.9 years (0.5-17.2; sd 4.1). Due to sensory, motor, or cognitive impairment some patients could not complete the full assessment.Parents reported increased financial constraints and fear of the future. CBCL-screening showed increased psychological symptoms in half of the patients; 13/40 (32.5%) patients classified for DSM-based diagnosis. While most patients expressed symptoms of anxiety and depression, we found a variety of externalising symptoms – particularly attention deficit and social conflicts in those patients who had renal replacement therapy in their first 3 years of life. Motor-development could be assessed in 47 patients using M-ABC. Lowest results were found in fine-motor development and manual dexterity (mean: 28.4; sd 29.0). Also balance-skills appeared to be affected (mean: 37.2; sd 31.6). Overall 11/47 (23.4%) of our patients had fine-motor skills below the 2nd percentile and 14/47 (29.9%) had balance-skills below this level.In 36 patients, who were classified as cognitively unimpaired, we assessed processing speed using WISC-V sub-tests. Mean score was 84 (45-112; sd 16.0). 5/36 (13.9%) participants scored below the 2nd percentile. Further 28 patients completed the number-connection test. Mean T-Score was 33 with 15/28 (53.6%) participants scoring below the 2^nd percentile.

*Conclusions: Although our sample was rather small, we could show a variety of challenges and comorbidities following kidney transplantation. Even after successful transplantation chronic kidney disease appears not to be limited to the impaired organ but a complex event. With patient and allograft survival being rather satisfactory these days, it’s high time to focus on the consequences of childhood CKD and transplantation. Not only is further research needed to further our understanding; rather clinical programmes need to be implemented to offer precise diagnosis and tailored therapeutic interventions to improve patient outcome and support their overall development.

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