This report concerns 296 children (67%males and 33% females) from 24 countries who started renal replacement therapy (RRT) for endstage renal failure between 1969 and 1988. Children under 2 years of age represented 3.6%, 4.4%, and 8.9% of all children under 15 years of age who started RRT in 1978–1982, 1983–1985, and 1986–1988 respectively. During the first 2 years of life,the most frequent causes of end–stage renal failure were renal hypoplasia and dysplasia (24%), and haemolyticuraemic syndrome (17%). During 1986–1988 the initial therapy for ESRF was continuous ambulatory peritoneal dialysis (CAPD) in 60%, haemodialysis 25%, intermittent peritoneal dialysis 8%, and 7% were transplanted without prior dialysis Between 1978 and 1988, 139 of these children were grafted; 53 received a graft (39 cadaveric, 10 living donor, 4 donor uncertain) below, and 86 (71 cada-veric, 14 living donor, 1 donor uncertain) above 2 years of age. One-year graft survival was 54% in the 53 children grafted below 2 years of age and 65% in the 86 grafted above 2 years of age. Only two of the 24 living donor grafts were lost during the first year after grafting. These results compare favourably with the 67% 1-year graft survival of all 278 children aged 2 to less than 6 years at grafting in 1978–1988 on the Registry's file The 3-year survival of all children aged less than 2 years at start of RRT was 65% in 1978–1982and rose to 78% in 1986–1988. Twenty-three percent of all deaths were caused by infections. In summary, the treatment of ESRF of children under 2 years of age has become more effective in recent years and continues to improve. There is still some way to go before the long-term benefitto these young patients is comparable with that of older age groups