Tacrolimus is a T cell-specific immunosuppressive agent that has been used in a relatively small number of pediatric kidney transplant recipients. It has been used as a primary immunosuppressive agent, with patient survival rates of over 95%, and graft survival rates of over 90%. In the largest series reported, some two-thirds of the successfully transplanted recipients have been taken off steroids, with substantial catch-up growth, and over 80% have been taken off antihypertensive medications. Important complications have included EBV-related post-transplant lymphoproliferative disorder and post-transplant diabetes mellitus, both reversible. Tacrolimus has also been used to rescue patients with refractory acute rejection, with a success rate of 70%-75%. This review summarizes the current world experience with tacrolimus in pediatric renal transplantation, and describes the details of tacrolimus dosing and the treatment of tacrolimus-related complications. On balance, tacrolimus is an effective immunosuppressive agent and offers important advantages in the management of pediatric renal transplant recipients.