Pediatric Kidney Transplant Program

The kidneys are an important organ that filter blood in order to remove waste and excess fluids from the body by converting them into urine. When the kidneys stop functioning properly, this causes waste to build up in the blood and damage the body.  This  is a life-threatening condition called kidney failure or end-stage kidney disease. Children with kidney failure must either go on dialysis or get a pediatric kidney transplant in order to survive. Many children who have a kidney transplant will go on to live a normal, healthy life after they recover from their transplant surgery.

A pediatric kidney transplant is a surgical procedure performed in children to replace a diseased or injured kidney with a healthy kidney from a donor. The kidney may come from an organ donor who has recently died or from a living donor, such as a family member or an individual who is a suitable match. In some cases, it is done in combination with other organ transplants, such as a liver or pancreas. If a child has severe kidney problems or kidney failure, a kidney transplant is often the best option.

The most common causes of kidney failure differ based on the child’s age:

Pediatric kidney transplantation is recommended for those children who have severe kidney problems or a disease that can lead to kidney failure. Conditions that may lead to kidney disease include:

Pediatric kidney transplants are the most common type of organ transplant performed in children. According to the United Network for Organ Sharing (UNOS), around 800 children in the United States undergo pediatric kidney transplants each year, which is about 5 percent of all kidney transplants performed nationally. While the demand for kidney transplants continues to exceed the supply of donor organs, as more kidneys are donated the number of kidneys that will be transplanted in children will increase as well.

There are two main types of pediatric kidney transplants:

Before your child can be considered for a pediatric kidney transplant, they must undergo a pre-transplant evaluation that consists of a series of tests and physical examinations. An evaluation is essential for the kidney transplant team to confirm if a transplant is the best treatment option for your child, and to identify the risks and benefits. The evaluation can take a few days to complete and is often done in an outpatient setting. The series of tests may include:

If the transplant team decides your child is qualified for a pediatric kidney transplant, they will be placed on the United Network for Organ Sharing (UNOS) kidney transplant waiting list. This is a list of all the people in the United States who require an organ transplant and need to be matched with an organ from a deceased or living donor. Children waiting for a pediatric kidney transplant are ranked and matched based on several factors including: how long they have been on the waiting list, the severity of their illness, blood type, weight, and location. If your child has a living kidney donor, such as a family member or friend, they may have their transplant surgery as soon as they are ready. The national average wait time on the donor kidney organ list is about six to 12 months for children.

When a healthy donor kidney becomes available, you will receive a call from the transplant team to promptly visit the hospital with your child. Upon arrival at the hospital, the transplant team will perform a physical exam and run blood tests to ensure your child is ready for pediatric kidney surgery. Then your child will be taken to the operating room, where they will be given general anesthesia through an IV line to put them to sleep during surgery. Once your child is asleep, the surgeon will make an incision in the lower abdomen and place the donated kidney. Typically, the recipient’s own kidney will not be removed unless it is infected.

Once the new kidney has been placed, the surgeon will sew the donor’s ureter (the tube that carries urine from the kidney to the bladder) to your child’s bladder. The vein and arteries of the new kidney will also be attached to the recipient’s vein and arteries. Upon completion, the surgeon will close the incision in the abdomen with surgical staples or stitches. The pediatric kidney transplant surgery typically takes between two to four hours to complete.

monitor, and may also have a ventilator with a breathing tube in the nose or mouth. They will usually spend several days recovering in the hospital and will be monitored closely. In some cases, your child will start producing their own urine right away, while sometimes, they may need to stay on dialysis for a few weeks until it starts occurring naturally.

The transplant nurse coordinators will educate you and your child about transplant medications. They will also work with you throughout your child’s hospitalization in order to teach you any special skills you may need to take care of your child at home. Examples of these skills include:

• How to take a blood pressure
• How to administer medications
• Wound care and dressing changes
• Detecting symptoms of rejection or infection
• Blood draws

Before your child is discharge from the hospital, you will receive detailed information regarding your child’s medication regimen, including doses, schedule, indications, and side effects. It is important to understand that your child will need to take immunosuppression medications for the rest of their lives after kidney transplant surgery. These medications are necessary to prevent complications like rejection, which occurs when the body perceives the new kidney as foreign and attacks them. As your child gets older, it will be crucial to teach them how to take their own medications and manage their own health.

After your child has received a pediatric kidney transplant, you and your family will need to make lifestyle changes to ensure your child stays healthy. It is important for your child to eat a healthy diet to recover from the surgery and help prevent complications. While your child will have fewer restrictions than if they were on dialysis, they will still need to eat a healthy diet and limit certain foods, such as processed foods or meals with high sodium.

The medication given to your child is known to increase appetite, which can lead to gaining weight quickly, so it is crucial to control weight gain through a healthy meal plan. A dietitian will work with you and your child to provide a nutrition plan that is the best fit. The transplant team will also provide a physical activity plan to support overall health.

Living with a kidney transplant is a life-long journey. Your child will need to take anti-rejection medication throughout their life with frequent follow-up visits to the pediatric transplant center to monitor progress. Over time, the transplant center visits will transition from weekly and monthly to yearly.  As your child transitions into adulthood, they will continue to be followed by the transplant center, and may be transferred to their adult post-care program.

If your child was dependent on dialysis before the pediatric kidney transplant, they will now be able to return to a more regular lifestyle without having to worry about following a dialysis schedule for treatments. Within a few months after transplantation, your child’s health will likely improve with more energy and a better quality of life. Many kidney transplant patients can return to school within a few months after the procedure.