Renal transplantation has been recognized as the treatment of choice for children with chronic renal failure principally because it can normalize their physiologic status and thus provide them with the potential for normal growth. The results of renal transplantation, however, have been mixed with some reports of excellent posttransplant growth and others with less optimistic results. Some of the differences among these studies may be because of the use of multiple methods to assess the success or failure of posttransplant growth. The usual methods have included assessment of the final adult height, growth velocity, presence of accelerated growth rates, change in height standard deviation scores, and growth survival. All of these methods have advantages and disadvantages in the description of the success or failure of growth after renal transplantation, but no single method stands out as the most appropriate to use in all circumstances. Furthermore, growth is dependent on a large number of complex and interrelated factors. At least four of these factors have been shown to affect the growth rates of children after renal transplantation: age at the time of transplant; allograft function; the type, dose, and schedule of immunosuppressive medication; and other endocrinologic factors. Finally, analysis of long-term growth patterns in children after renal transplantation has shown that growth rates frequently decrease over time. Even children who have grown well immediately after the transplant may develop growth failure after several years. We conclude that the majority of children with renal transplants can experience normal or even accelerated growth rates after the procedure. Unfortunately, growth rates subsequently tend to decline in most children.(ABSTRACT TRUNCATED AT 250 WORDS)