Pediatric General Knowledge

Why do children need kidney transplants?

Children can experience kidney problems – and kidney failure – for a number of reasons, including:

Congenital urinary tract or kidney disorders
Inherited kidney disorders such as autosomal recessive polycystic kidney disease (ARPKD) (typically children with ARPKD will need a kidney transplant by the age of 10)
Acquired kidney disorders such as focal segmental glomerulosclerosis (FSGS)
Other diseases that can destroy the kidney such as vasculitis, autoimmune diseases, or hemolytic uremic syndrome (HUS).

Stable kidney function can often be maintained successfully with medications and/or surgery before a kidney transplant is needed, but when kidney failure progresses it can cause growth issues, decreased school performance, bleeding issues, decreased appetite and lower energy levels in children. For these reasons, kidney transplantation is preferably performed before the child requires dialysis, which is called preemptive transplantation. In children, hemodialysis or peritoneal dialysis is considered only as a bridge to transplantation,

What are the benefits of a kidney transplant?
Successful kidney transplantation can almost restore a child’s normal life.

What are the potential risks and complications?

As with any medical or surgical treatment, there are potential complications involved. Potential risks and complications include the following situations:

In some cases, the transplanted kidney will fail to work or be rejected by the recipient's body at any time. Then the recipient would need to have another kidney transplant or be on dialysis and while waiting for another kidney transplant.
Anti-rejection medications need to be taken for as the life of the transplanted kidney. These medications have many possible side effects, and the long-term expense of these medications is an important factor for families to consider.
In some patients the original kidney disease can return after transplant. Transplant candidates must discuss their individual risk for recurrence with a nephrologist.
If a living donor is not available, there is often a long waiting period for a deceased donor kidney in adults, but is much shorter in children.

How is a kidney transplant for a child different than for an adult?

Transplantation in children differs from adult transplantation. Not only are children smaller than adults, but they also have special emotional and medical needs. So that children can reach their full potential, their care must be focused on the fact that they are constantly growing and developing. That is why it is important that professionals who are trained in pediatric care perform pediatric transplantation. Other differences include:

Children typically must be a certain age and size. Children undergoing transplants receive adult kidneys – kidneys they can “grow into.” For this reason, it’s important for there to be enough space in the abdomen to hold an organ larger than is typical for a child. Manycenters prefer to wait until a child is 18 months old or 22 pounds; however, transplants have been successfully performed in children weighing as little as 18 pounds, but that depends on the underlying condition of the child, as well as the expertise of the surgeon. The more experience a transplant center has, the higher the success rate.
Finding a donor before a child’s kidneys fail can be tough, especially since doctors avoid putting a child on dialysis and prefer preemptive kidney transplants. There is no one sure and fast way to know when this will occur. End-state renal failure occurs at different times for different children.
Some children with ARPKD have such large cystic kidneys that one or both will need to be removed before a new kidney can fit in the abdomen. This is called a nephrectomy.