Kidney Transplantation in Children

When a child has been diagnosed with end-stage renal disease, his/her kidneys are no longer working properly. The kidneys have two major jobs: to remove fluid and to clear the body of waste products. If the kidneys no longer work, dialysis or a new kidney (transplantation) is needed to keep the patient alive. Diseases that cause kidney failure in children vary by the age of the child.

Renal failure is less common in children than adults. Among the children under the age of 12, the most common causes of kidney failure are problems with the structure of the kidney, bladder, or anywhere along the urinary tract. Most children are born with these problems. In many cases of structural kidney disease, surgery is required either to preserve kidney function, to manage urinary problems, or to prepare patients for renal transplantation. In children over the age of 12, glomerulonephritis (inflammation of the kidneys) is the most frequent cause of kidney failure
Renal failure in childhood is very different from renal failure in adults. While kidney disease is a complicated chronic illness affecting many aspects of a child’s life, it is a manageable condition. The goal of treatment is to have the patient lead a normal life.

Problems Specific to Children

Everyone who has kidney failure, adults and children alike, will experience medical complications, which may include extreme fatigue, inability to concentrate, weak bones, nerve damage, depression, and sleep problems. Additional problems for children can include effects on their growth and development. Children may fall behind on the growth chart and in school. Failure to grow has been a common problem among children with chronic kidney disease, but improved medications such as recombinant growth hormone, nutritional supplements, and human recombinant erythropoietin have allowed for normal growth in many patients.

What is a kidney transplant?

The kidney may come from a deceased organ donor or from a living donor. Family members or individuals who are unrelated but make a good match may be able to donate one of their kidneys. This type of transplant is called a living transplant. Individuals who donate a kidney can live healthy lives with the remaining kidney.

Transplantation (placing another person’s kidney into the abdomen of the patient) is generally the treatment of choice for children with ESRD. The new kidney would function as though it were the patient’s own kidney. A renal transplant may allow the child an opportunity for better growth than dialysis treatments and for more normal participation in school and activities with peers. In addition, there may not be as many diet restrictions once the patient has a new kidney.

Many parts of renal transplantation in children are no different from those in adults. Usually adult kidneys are transplanted into small children. If possible, a living related kidney transplant is preferred because there is a lower chance of rejection and better long-term kidney survival. Preparation for a kidney transplant is complex and requires a full range of medical services. The child is tested to assure that he is healthy and prepared for the procedure. Immunizations are updated. The child is tested for infections. In some cases, surgery to correct bladder problems may be necessary before transplantation.

A person receiving a transplant usually receives only one kidney, but, in rare situations, he/she may receive two kidneys from a deceased donor. In most cases, the diseased kidneys are left in place during the transplant procedure. The transplanted kidney is implanted in the lower abdomen on the front side of the body.
A kidney transplant is recommended for children who have serious kidney dysfunction and will not be able to live without dialysis or a transplant.

A child receiving a transplant usually receives only one kidney, but, in rare situations, he/she may receive two kidneys from a cadaveric donor.

Family members or individuals who are unrelated but make a good match may also be able to donate one of their kidneys. This type of transplant is called a living transplant. Individuals who donate a kidney can live healthy lives with the kidney that remains.

Preemptive Transplantation

Preemptive transplantation means that the child receives a donated kidney before dialysis is needed. Some studies indicate that preemptive transplantation reduces the chances of rejecting the new kidney and improves the chances that it will function for a long time. Other studies show little or no survival advantage in preemptive transplants, although some families may feel that avoiding dialysis is an advantage in itself.

Potential Benefits of Kidney Transplantation

Successful kidney transplantation can increase a child's energy level and provide an improved quality of life. Kidney transplantation also offers these advantages over dialysis:

• Eliminates the need for life-long, daily dialysis treatments
• Fewer diet restrictions
• Improved appetite and growth
• Less rigid daily schedule when dialysis no longer needed

Potential Risks and Complications

Transplant candidates and their families must also consider the potential for surgical complications and other risks that accompany transplant surgery. 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 dialysis and wait for another kidney transplant.
• Anti-rejection medications need to be taken for as long as the transplanted kidney functions. 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.