With improving graft survival, growth post-transplantation, demands increasing attention from pediatric transplant physicians. As our data base matures, the North American Pediatric Renal Transplant Cooperative Study is able to track growth patterns longitudinally. Of 2086 patients enrolled in the registry, 412 patients have had a functioning graft for at least three years. The mean growth deficit for this group was -2.46 and the change in Z score at three years was 0.16 (P < 0.01). Of various factors that could conceivably impact on growth post-transplantation such as donor source, race, number of transplants, and immunosuppressive therapy, only age at transplant and the original height deficit are significant. Most growth retarded children over the age of six years are unlikely to exhibit accelerated growth post-transplantation.