Kidney Transplantation in Children
What is a kidney transplant?
A kidney transplant is surgery to place a healthy kidney from another person into
someone with severe kidney problems. The healthy kidney may come from two types of
Deceased donor. This is an organ donor who has just died.
Living donor. Family members or people who are unrelated but make a good match may be able to donate
one of their kidneys. This is called a living transplant. People who donate a kidney
can live healthy lives with their one remaining kidney.
A person receiving a transplant usually receives only one kidney. But in rare cases
a person may receive two kidneys from a deceased donor. In most cases, the diseased
kidneys are left in place during the surgery. The transplanted kidney is placed in
the lower belly (abdomen) on the front side of the body.
Why is a kidney transplant recommended?
A kidney transplant is recommended for children who have serious kidney problems and
will die without dialysis or a transplant. Some of the kidney diseases in children
that may require a transplant include the following:
Birth defects and heredity diseases. These are the most common causes of kidney failure in children from birth to age
Hereditary diseases, nephrotic syndrome, and systemic diseases. These are the most common cause of kidney failure in children between ages 5 and
Diseases that affect the blood vessels (glomeruli) in the kidneys. The most common cause of kidney failure in children between ages 15 and 19.
Not all children with these diseases will need a kidney transplant. Always see your
child's healthcare provider for a diagnosis.
Where do transplanted organs come from?
There are two types of donors: deceased donors and living donors.
Most transplanted kidneys come from deceased organ donors. This is called a deceased
donor transplant. These organ donors are adults or children who have become critically
ill and are pronounced dead because their brain or their heart has stopped working. If
the donor is an adult, he or she may have agreed to be an organ donor before becoming
ill. The family of the deceased person must agree to donate the person's organs. Donors
can come from any part of the U.S. A child receiving a transplant usually receives
only one kidney. But in rare cases a child may receive two kidneys from a deceased
donor. Researchers are also experimenting with splitting one kidney for two recipients.
Family members or people who are not related but are a good match may also be able
to donate one of their kidneys. This is called a living transplant. People who donate
a kidney can live healthy lives with the one kidney that remains. A child over age
2 can generally receive an adult kidney. There is usually enough space in the child’s
belly for the new kidney to fit.
What is the transplant waiting list?
If your child is accepted as a transplant candidate, he or she will be placed on a
national transplant waiting list. When a donor organ becomes available, a computer
searches all the people on the waiting list for a kidney. Those who are not good matches
for the available kidney are set aside. A new list is made from the remaining candidates.
The person at the top of the specialized list is considered for the transplant. If
he or she is not a good candidate, for whatever reason, then the next person is considered.
In some cases, people lower on the list may be considered before a person at the top.
This can happen for different reasons. These include the donor organ’s size or how
far away the donor is from the recipient.
How is my child placed on the waiting list for a new kidney?
Talk with your child’s healthcare team to see if a transplant is an option for your
child. If it is, then have your child’s provider refer you to a transplant center
in your area. Transplant centers are located in certain hospitals throughout the U.S.
Your child must complete a full evaluation at the transplant center.
The kidney transplant team
Your child will have a variety of tests done by the transplant center team. This
is the group of specialists who evaluate people to see if they can have a transplant
procedure. They also care for people undergoing a transplant. The team will decide
if your child is a candidate for a transplant. The transplant center team will include:
Transplant surgeons. Doctors who specialize in transplantation and who will be performing the surgery.
The transplant surgeons coordinate all team members. They follow your child before
the transplant and continue to follow your child after the transplant and after discharge
from the hospital.
Nephrologists. Doctors who specialize in disorders of the kidneys. Nephrologists will help manage
your child before and after the surgery.
Urologists. Doctors who specialize in diagnosis and treatment of disorders of the genitourinary
Transplant nurse coordinator. A nurse who organizes all aspects of care provided to your child before and after
the transplant. The nurse coordinator will provide patient education and coordinate
the diagnostic testing and follow-up care.
Social workers. Professionals who will provide support to your family and help your family deal
with many issues that may arise, including lodging and transportation, finances,
and legal issues. They can also help coordinate alternative means for school, so
that your child does not get behind.
Dietitians. Professionals who will help your child meet his or her nutritional needs before
and after the transplant. They will work closely with you and your family.
Physical therapists. Professionals who will help your child become strong and independent with movement
and endurance after the transplantation.
Pastoral care. Chaplains who provide spiritual care and support.
Other team members. Several other team members will evaluate your child before transplantation and provide
follow-up care, as needed. These include, but are not limited to, the following:
The transplant evaluation process
An extensive evaluation must be done before your child can be placed on the national
transplant waiting list. Testing includes:
Tests are done to gather information that will help determine how urgent it is that
your child is placed on the transplant list. These tests also ensure your child receives
a donor organ that is a good match. Tests include those to analyze your child’s general
Heart, lung, and kidney function
The presence of infection
Blood tests will help improve the chances that the donor organ won’t be rejected.
These tests may include:
Blood chemistries. These may include serum creatinine, electrolytes (such as sodium and potassium), cholesterol,
and liver function tests.
Clotting studies, such as prothrombin time (PT) and partial thromboplastin time (PTT). These tests measure the time it takes for blood to clot.
Other blood tests will help improve the chances that the donor organ will not be rejected.
They may include:
Your child's blood type. Each person has a specific blood type: type A+, A-, B+, B-, AB+. AB-, O+, or O-. When
receiving a transfusion, the blood received must be a compatible type with your child's
own. If not, an allergic reaction will occur. The same allergic reaction will occur
if the blood contained within a donor organ enters your child's body during a transplant.
Allergic reactions can be avoided by matching the blood types of your child and the
Human leukocyte antigens (HLA) and panel reactive antibody (PRA). These tests help figure out how successful an organ transplant may be. The tests check
for antibodies in your child's blood. Antibodies are made by the body's immune system
in reaction to a foreign substance, such as a blood transfusion or a virus. Antibodies
in the bloodstream will try to attack transplanted organs. Children who receive a
transplant will take medicines that decrease this immune response. The higher your
child's PRA, the more likely that an organ will be rejected.
Kidney, liver, and other vital organ function tests
Viral studies. These tests determine if your child has antibodies to viruses that may increase the
likelihood of rejecting the donor organ, such as cytomegalovirus (CMV). Many other
infectious diseases are also tested for, including HIV and hepatitis.
Extensive diagnostic tests are also done. They are needed to understand your child’s
complete health status. Other tests may also be done, including the following:
Kidney ultrasound. For this noninvasive test, a probe (transducer) is passed over the kidney on the
outside of the body. The probe creates sound waves that bounce off the kidney. The
sound waves transmit a picture of the kidney onto a video screen. This test is used
to determine the size and shape of the kidney. It can also see if there is a mass,
kidney stone, cyst, or other blockage or abnormality.
Kidney biopsy. Tissue samples are removed (with a needle or during surgery) from the kidney and
checked under a microscope.
Intravenous pyelogram (IVP). A series of X-rays of the kidney, ureters, and bladder. Contrast dye is injected
into the vein to find tumors, abnormalities, kidney stones, or any blockages, and
to assess renal blood flow.
Getting on the list
The transplant team will consider all the information gathered from interviews, your
child's medical history, and the evaluation tests. Based on this information, the
team will decide if your child is a transplant candidate. If your child is a candidate,
the transplant team will add him or her to the national transplant waiting list. If
you have any questions about your child’s place on the list, ask the transplant team.
How long will it take to get a new kidney?
There is no definite answer to this question. If there is a matching and healthy living
donor, your child may be able to get a transplant in a few weeks or months. If no
living related donor is available, it may take months or years on the waiting list
before a suitable donor organ is available. During this time, your child will receive
close follow-up with his or her healthcare providers and the transplant team. Many
support groups are also available to help you during this waiting time.
How are we notified when a kidney is available?
Each transplant team has their own specific guidelines for waiting on the transplant
list and being notified when a donor organ is available. In most cases, you will receive
a phone call that an organ is available. You will be told to come to the hospital
immediately so your child can be prepared for the transplant.
What is involved in kidney transplant surgery?
Once an organ becomes available to your child, you and your child will be immediately
called to the hospital. This call can occur at any time. So you should always be prepared
to go to the hospital, if needed. Once at the hospital, your child will have some
more final blood work and tests to confirm the organ is a match.
Your child will then go to the operating room. The transplant surgery may take several
hours. But this will vary greatly depending on each individual case. During the surgery,
a member of the transplant team will keep you informed on how the surgery is going.
Postoperative care for kidney transplant
After the surgery, your child will go to the intensive care unit (ICU) to be watched
closely. The length of time your child will spend in the ICU will vary. It will be
based on your child's unique condition. After your child is stable, he or she will
be sent to the special unit in the hospital that cares for kidney transplant patients.
Your child will continue to be watched closely. You will be educated on all aspects
of caring for your child during this time. This will include information about medicines,
activity, follow-up, diet, and any other specific instructions from your child's transplant
What is rejection?
Rejection is the body’s normal reaction to foreign tissue. When a new kidney is placed
in a person's body, the body sees the transplanted organ as a threat and tries to
attack it. The immune system makes antibodies to try to kill the new organ. To help
the new kidney survive in your child’s body, your child must take antirejection medicines
(immunosuppressants). These medicines weaken the immune system’s response. Your child
must take these medicines for the rest of his or her life.
What are the symptoms of rejection?
Each child may experience symptoms of rejection differently. Symptoms may include:
Your transplant team will tell you who to call right away if any of these symptoms
What is done to prevent rejection?
Your child must take antirejection medicines for the rest of his or her life. Each
child may react differently to medicines, and each transplant team has preferences
for different medicines. Some of the antirejection medicines most commonly used include
New antirejection medicines are always being approved. Your child’s healthcare provider
will create a medicine treatment plan that is right for your child. The doses of these
medicines may change frequently as your child's response to them changes. Antirejection
medicines affect the immune system. So children who receive a transplant will be at
higher risk for infections. A balance must be maintained between preventing rejection
and making your child very vulnerable to infection. Your child will have blood tests
done regularly. These will measure the amount of medicine in your child’s body and
make sure your child does not get too much or too little of the medicines. White blood
cells are also an important indicator of how much medicine your child needs.
What about infection?
This risk of infection is especially great in the first few months after the transplant.
That’s because higher doses of antirejection medicines are given during this time.
Your child will most likely need to take medicines to prevent other infections from
occurring. Some of the infections your child will be especially vulnerable to include
oral yeast infection (thrush), herpes, and respiratory viruses.
Long-term outlook for a child after a kidney transplant
Living with a transplant is a lifelong process. Medicines must be given that trick
the immune system so it won’t attack the transplanted organ. Other medicines must
be given to prevent side effects of the antirejection medicines, such as infection.
Frequent visits to and contact with the transplant team are essential. It’s very important
to know the signs of organ rejection and to look for them each day. When your child
is old enough, he or she will need to learn about antirejection medicines. Your child
will need to learn what these medicines do and the signs of rejection. Over time your
child must be able to care for himself or herself independently.
Every child is unique and every transplant is different. Results keep improving as
healthcare providers and scientists learn more about how the body deals with transplanted
organs and search for ways to improve the transplant process.