Pediatric Kidney Transplants

When a child is diagnosed with end-stage kidney disease, it means that the kidneys have stopped working and waste is no longer being removed from the blood. This can make a child sick. Your child’s doctor may refer to this as kidney failure. Once the kidneys stop working, a transplant may be your child’s best treatment option.

How will a kidney transplant help my child?

A kidney transplant is an alternative to dialysis treatment, which removes waste from your child’s blood. Only one kidney is needed to efficiently clean the blood and replace two failing kidneys.

What is a transplant evaluation?

At the right time, a nephrologist (kidney specialist) will refer your child for a transplant evaluation. The evaluation includes:

• Meetings with the transplant team to discuss the surgery, hospital stay, medications needed after a transplant and outpatient follow-up arrangements, amongst other things. These meetings are usually completed over one or two days.
• Testing including blood work and radiologic imaging, such as an ultrasound. 
• A bladder evaluation to make sure the lower urinary tract is ready for a kidney transplant.

What happens after my child is approved for a kidney transplant?

Once your child is evaluated and approved, they are placed on the United Network for Organ Sharing (UNOS) transplant list. There are two options for pediatric kidney transplants, live organ donation and deceased organ donation.

What is a live donor kidney transplant?

Any adult can donate a kidney to a child in need if their blood type matches the intended recipient and if they “pass” the donor evaluation. This can be a parent or other family member (living-related donor), a friend, or even a stranger (living un-related donor). A donated kidney does not necessarily require identical blood types between donor and recipient, but certain compatibility criteria needs to be fulfilled to be approved as a match.

Live donor kidney transplants have advantages over deceased donors, including a shorter wait time for an organ, easier and more convenient planning and scheduling of the transplant surgery, a potential for a better genetic match than a deceased donor, and better long-term outcomes.

Kidneys from living donors tend to work better and longer than kidneys from deceased donors, but a kidney transplant from a deceased donor is still a better option than long-term dialysis. A living kidney donation is not entirely risk-free and comes with some hardships for the donor, such as time off work. Living kidney donation also means that the donor, purely out of the goodness of their heart, undergoes a surgical procedure that they don’t need for their own physical well-being. Get more information about live kidney donation.

How does Children’s Colorado help my family organize a kidney transplant?

At Children’s Colorado, we have a multidisciplinary team of transplant surgeons, nephrologists, transplant coordinators, social workers, dietitians, pharmacists, psychologists and pediatric urologists who work together to treat children who need a kidney transplant.

A transplant coordinator is a family’s main point of contact for scheduling multiple specialists, answering questions about what happens next and, most importantly, helping to simplify a complex journey.

How do I prepare my family for a transplant?

Before the operation, families meet with a pediatric anesthesiologist who explains the sleep-like state of anesthesia. You are able to ask questions, and ease any concerns that you have about pain management during and after surgery.

Also, Children’s Colorado offers pre-surgery tours to help your family prepare for surgery. If your child is too young, we also have a pre-surgery video to share or helpful tips about how to talk to your child and their siblings about surgery. And, to put your mind at ease, read through 10 ways to help you choose the best hospital for your child’s surgery.

What happens during a kidney transplant operation?

During the evaluation, a transplant surgeon explains the details of the transplant specific to your child. Below is a basic description of a kidney transplant.

1. Our dedicated pediatric transplant surgeon begins the operation by making an incision in the lower abdomen.
2. Then, the surgeon places the new kidney into the pelvic area and connects it to blood vessels and the bladder. There are three main connections including two blood vessels (renal artery and vein) and the ureter (the tube that brings urine out of kidney to the bladder). These connections are separate from the native kidneys. Kidney failure causes the native kidneys to shrink, and, as a result, they usually are not removed. They continue to shrink due to the disease and don’t affect the healthy donor kidney. If it’s necessary, your transplant surgeon will explain removal during the evaluation.
3. Some children with kidney failure have related bladder and urologic conditions. If this is the case, a pediatric urologist can treat those conditions during the same operation if necessary. 

How long does a transplant operation last?

On average, it takes about three hours.

What to expect during your child’s hospital stay for a kidney transplant

The first day after a child receives a new kidney, they stay in the Pediatric Intensive Care Unit (PICU) for monitoring. Then, they move to a regular room for an additional four to six days. Your child’s new kidney typically starts to filter blood and produce urine almost right away. The care team at the hospital will monitor for infections, complications and overall well-being.

When your child wakes up, he or she may have a few tubes, called catheters, connected to his/her body, including:

• A bladder catheter to control urine.
• A central venous catheter monitors fluid and blood volume status, and to provide anti-rejection medication. 
• Sometimes, a stent (tube) placed in the transplant ureter (the tube, which brings urine out of kidney to the bladder) to help heal the new bladder connection. This is removed by a pediatric surgeon or a pediatric urologist between two and four weeks after surgery along with the dialysis catheter, if your child has one. 

While in the hospital, a pediatric nephrologist monitors blood pressure and anti-rejection medication to find the right balance.

The transplant team will discharge you from the hospital once the bladder catheter and the central venous catheter are removed. They will also make sure your child is healing well, eating and having normal bowel function.

What can patients and families expect after a kidney transplant?

After, your child will continue to see a pediatric nephrologist twice a week for the first few weeks, who manages anti-rejection medicine and additional medical care. Your child will take medications to reduce the risk of infection, complications and to stop his or her body from attacking the new kidney(s). 

Within four to six weeks, kids should be fully recovered and back to normal, age-appropriate activities. Our goal is to get your child back to a regular quality of life and not be limited by a transplant – this means kids can go to school, play sports and eat a normal diet.

Because transplanted kidneys have a finite life-span, some patients may need another kidney transplant later in life. Your child’s nephrologist will help you care for your child’s health and make sure the donor kidney lasts as long as possible.