Understanding Pediatric Kidney Transplants

What is a Kidney Transplant? 

A pediatric kidney transplant is a surgical procedure that replaces a diseased kidney in a child with a healthy kidney from a donor. It is the preferred treatment for children with end-stage renal disease (ESRD), which is the complete failure of the kidney function. 

Why Would a Child Require a Kidney Transplant? 

Kidneys are vital organs that filter waste products and excess fluid from the blood. When the kidneys fail, waste products can build up in the blood, leading to serious health problems. Kidneys can fail in a child due to various anatomical and genetic causes. A kidney transplant can typically improve a child's quality of life and allow them to grow and develop normally. 

Types of Kidney Transplants

Living Donor Kidney Transplantation

Fi​rst performed in the United States in 1954, living-donor kidney transplants have steadily increased each year. A living-donor kidney transplant may be an option that is offered to the parents or other adult loved ones of a child who requires a kidney transplant. 

At Lurie Children’s, approximately 30% of all kidney transplants performed to date have been living donor operations. Donors have included p​arents, cousins, aunts, uncles, grandparents and family friends.  

Selecting a ​Donor

The potential living kidney donor must meet certain age and health criteria, as well as have the same or compatible blood type as the recipient.

• ​The donor should be of overall excellent health without significant medical problems such as diabetes, obesity, heart disease, hypertension or active cancer.  Donors must wait at least 1 year after giving birth to be eligible for donation surgery. 
• We generally do not consider individuals below the age of 18 or over the age of 50 as potential donors. 
• Most importantly, the donor must be willing and able to withstand the stress of donation and recovery from major surgery. 

We encourage parents to have their blood types (ABO) checked to determine if one or both are a match. These results may already be available from a donor’s obstetrician’s office if they have previously been pregnant or Blood Donation Center if they have donated blood in the past. It is not a routine test drawn annually from your Primary Care Physician and would need to be specially requested. If multiple parents and loved ones are a match, the family needs to decide who would make the most suitable donor. Some issues for consideration are: employment (who is the primary breadwinner), work demands (sedentary or physical), sick-leave limitations and available support systems. 
 
If an interested donor does not have a compatible blood type but is otherwise in excellent health, there is an option to be considered for evaluation for the Paired Kidney Donation program (KPD) or “kidney swap.” 

Donor Evaluati​on 

The donor work-up is initiated when a suitable​ donor is identified. The donor evaluation will consist of:

• Laboratory testing 
• Medical exam 
• CT scan of the kidney to measure size and rule out abnormalities 
• ECG, chest X-ray 

Because living donors are adults, all donor evaluation and testing procedures are perform​ed independently at Lurie Children’s adult partner hospital, Northwestern Memorial Hospital​. Most donor evaluation appointments and surgery are covered by the recipient’s insurance; however, it is the responsibility of the donor to clarify this coverage with the Northwestern Medicine Living Donor Center staff and their own personal insurance. Other than notifications of a donor’s approval or denial to donate, all other donor evaluation updates (including donor name and medical history) are not shared with the recipient family but can be shared privately if the donor wishes to share this information with the child’s family. Once a donor is approved and the child is medically ready to proceed with surgery, the transplant teams from Lurie Children’s and Northwestern Medicine work together with the family to select a date for the transplant. 

Living-Donor Transplant Surgery

The child is admitted to Lurie Children’s transplant unit the night before or the morning of the scheduled surgery, depending on the child’s dialysis schedule. The donor will report to Northwestern Memorial no later than 6 a.m. ​on the day of surgery. 

The donor operation begins at about 7:30 a.m.,​ and the two transplant teams are in constant communication thereafter. Once the donor kidney is removed, the team at Lurie Children’s starts the recipient’s procedure. While the donor operation normally​ takes two to three hours, the recipient’s procedure may last approximately four to six hours. The donor will not be able to visit the recipient until they are medically discharged from Northwestern Memorial Hospital. 

Pros ​and Cons

The most important advantage to living donor kidney transplant is the ability to schedule the surgery on an elective basis. This allows the transplant team, along with the family, to decide on the optimum time for the procedure. The recipients are usually healthier and stronger at the time of transplant as well.​ 

Living donor recipients may have shorter hospital stays and may have fewer episodes of moderate to severe rejection. On the other hand, the family must be ready to provide physical and emotional post-operative care to two family members, rather than just the recipient such as in the case of a deceased donor transplant. The living donor operation, w​hile typically performed laparoscopically and considered minimally invasive, is still a surgical procedure with risks. These risks include but are not limited to bleeding and infection.  

Most donors are discharged from the hospital w​ithin two days and back to work within two weeks, very often starting with half days and then increasing hours from there. The donors are encouraged to avoid heavy lifting (no more than 5-10 pounds) for at least six weeks after their surgery.  

Deceased-Donor Kidney Transplantation 

When a living donor kidney transplant is not a possibility, a deceased donor kidney transplant may be the best option. The process for deceased donor transplantation is as follows: 

• ​A donor is identified by the hospital staff at the donor hospital. 
• The local Organ Procurement Organization (OPO) is notified, and an OPO representative is sent to the donor hospital to evaluate the donor. 
• Once the donor has been evaluated and deemed acceptable, the donor family is approached for education and consent. 
• If consent is obtained, a match list is obtained by the United Network of Organ Sharing​ (UNOS). The match list is an organ-specific ranking list that shows the patient’s name and what center they belong to. This is called the organ allocation list. This process will be discussed at length during the evaluation by the procurement coordinators. 
• The OPO makes organ offers by notifying the centers at the top of the list. Each center has a designated 24-hour call person to take the offer. The surgeon and kidney doctors will make the ultimate decision to accept or decline an offer. 
• If the organ is accepted, the organ procurement coordinators will notify the families and hospital staff. We ask that you always keep your phone on, once your child is on the active deceased donor list, to make sure you are reachable. If the guardian cannot be reached to accept the offer, the kidney will be offered to the next person on the waitlist. 
• The organ procurement coordinators will be a means of communication between the operating room and a patient’s family. 

After Kidney Transplantation

After a successful pediatric kidney transplant, there are several stages of recovery to focus on: 

Hospital Stay (First week): 

• Monitoring: The transplant team will closely monitor the child's condition to ensure the new kidney is functioning properly. This includes urine output management via urinary catheter, blood tests, checking for signs of infection and managing pain medication.
• Learning about medications: You'll be introduced to the immunosuppressant medications the child will need to take for life to prevent rejection of the donor kidney. These medications can have side effects, so understanding them and proper administration is crucial.
• Early recovery: Encouraging the child to walk and participate in light physical activity is important for healing and preventing blood clots.

Follow-up care (After discharge):

• Frequent checkups: For the first few months, appointments with the transplant team will be frequent (starting at twice per week), allowing for close monitoring of the new kidney's function and adjusting medications as needed. After the initial intense monitoring period, follow-up appointments become less frequent. These checkups involve blood tests, blood pressure monitoring and evaluation of the kidney function.
• Infection prevention: Since immunosuppressant medications weaken the immune system, preventing infections becomes a priority. This involves good handwashing hygiene for everyone at home, avoiding sick people and following doctor's instructions regarding vaccinations. 
• Healthy lifestyle: Maintaining a healthy diet, regular exercise and getting enough sleep are all important for a child's overall health and the success of the transplant. 
• Emotional well-being: Pediatric transplants can be emotionally challenging for both the child and the family. Talk to a doctor about any emotional concerns and seek support groups if needed. 
• Medication management: Immunosuppressant medications will be a lifelong requirement, and dosages may be adjusted over time. Careful monitoring for side effects and compliance with the medication regiments are crucial.

Overall, while recovery from a pediatric kidney transplant takes time and ongoing management, it offers a chance for a child to live a healthy and active life.