Pediatric kidney transplantation has improved significantly over the past decade. Living donors provide better outcomes than deceased donors, with steady improvements in short and long-term graft survival rates. Around 33% of pediatric transplant patients require urologic surgery like augmentation or catheterizable channels before transplantation. Careful medical evaluation of both recipients and living donors is essential to maximize outcomes. Post-transplant care involves immunosuppression, infection prophylaxis, and management of potential urologic complications.