Paediatric Kidney Transplantation: All You Should Know

Till a few decades ago, end-stage renal disease (ESRD)was considered untreatable. Today, 1 in 6500 children suffers from ESRD. Read on to know more.

By Dr Saumil Gaur  • 9 min read

Paediatric Kidney Transplantation: All You Should Know

In today’s age, medical advancements in surgical techniques like paediatric kidney transplant and post renal transplant have dramatically brought down the mortality rates of children with chronic renal failure. However, studies have revealed that ESRD patients still have a higher rate of mortality and morbidity.

The good news is paediatric speciality hospitals in our country are now well equipped to perform different types of kidney surgery and have brought in advanced technologies to make the kidney transplant procedure for children smooth.

Generally, parents become worried or confused when they are told that their child needs to undergo kidney transplantation. In addition to their worry, there is limited awareness of the condition and the treatment facilities available while choosing the hospital. It is important to note that the appropriate doctor to organise kidney transplant in children is a paediatric nephrologist and not a regular nephrologist as there is a difference between child and adult physiology. This is an important piece of information most parents are unaware of.

"A child who is 10 years old and is still bedwetting should be taken to a specialist treating this condition. The instructions given by the doctor should be followed religiously, for a long time, to get the desiredresult.
— Dr Vivek Rege, Paediatric Surgeon and Paediatric Urologist, Neonatal Surgeon

What causes kidney failure

The most common causes of kidney failure in youngsters range from genetic diseases like congenital anomalies of kidneys (an aberrant formation of kidneys in the foetal stage) leading to progressive kidney failure in childhood.

Other common causes are Nephritis / Nephrotic syndrome in which the tiny filtering units called nephrons in the kidney are damaged.

When kidneys fail: Reasons for kidney transplant

Once the kidneys have failed, the options for survival are limited as the blood purification process halts. In such a situation, purification is done through dialysis.

What is kidney dialysis?

Dialysis is a process that filters and purifies the blood with the help of a machine. There are mainly two types of dialysis – hemodialysis and peritoneal dialysis. It may be effective but when used on children for a long period compromises the quality of life. Hence, it is recommended that early kidney transplant is performed in children to improve the quality of life.

Normally, kidney transplantation is required when the kidneys are unable to purify blood. This usually happens when kidney function falls below 10-15 per cent of the normal range.

Any child who is more than 10-12 kg and is above the age of two years can undergo transplant and accept and even accommodate an adult kidney in his body.

One of the most important conditions is the presence of an able dedicated paediatric kidney transplant team led by a well-qualified and able paediatric nephrologist.

"If your child has any genital or urinary complaints, he must be taken to a paediatric urologist. Common problems that children suffer from are urinary infection with fever, recurrent urinary infections, experiencing pain and burning while passing urine, straining while passing urine, frequent urination, urinary incontinence, and abdominal pain in the flanks with pain radiating down to the genital region.
Some children also have congenital defects like undescended testis, phimosis, balanoposthitis and hydronephrosis with obstruction at junction of pelvis and ureter, or ureter and bladder. Other conditions that the child may be suffering from are reflux of urine from the bladder to the kidney, outlet obstruction (in males) called posterior urethral valves, duplicated kidneys, and so on.
— Dr Vivek Rege, Paediatric Surgeon and Paediatric Urologist, Neonatal Surgeon

Types of kidney surgery

1. Living donor transplant: As the name suggests, in this procedure, a child gets a kidney from a living person. One healthy kidney can do the work of two failed kidneys. Unlike other organs, a kidney can be received from a living donor. As per the Human Organ Transplant Act, first degree blood relatives like parents, grandparents or a sibling who is more than 18 years of age can donate the kidneys. Unrelated kidney transplants are not considered for the process except in circumstances when there is no available blood relative.

2. Non-living–donor transplant: As the name suggests, a kidney transplantation is carried out in this case when the donor is dead, and his organ is used for transplantation. The patient might require waiting in this case.

Once a suitable kidney is found for the transplantation, the child can be taken to the hospital for the procedure. In the hospital, a blood sample will be taken for an antibody crossmatch test. This test determines whether the child's immune system will be able to accept the new kidney.

If the test comes back negative, the kidney is considered safe and acceptable and the transplant can begin. The surgical procedure starts with a general anaesthesia. The new kidney will be placed in the abdomen and the surgeon will attach the kidney's blood vessels to the blood vessels in the lower body. The new kidney's ureter tubes (tubes that carry urine) will be connected to the bladder. The procedure usually takes three to four hours. Once the process is done, the kidney will start working right after the surgery, or after a few weeks.

In recent years, the cases of paediatric kidney stones have increased in children. Know about the causes, symptoms, treatments, and home remedies for kidney stones in children.

Post renal transplant

After the kidney transplant surgery is completed, acute monitoring is required to ensure there are no complications such as bleeding or infection. In most cases, the immune system will recognise a new kidney as a foreign object and attempt to reject it. Lifelong anti-rejection medication could help the child overcome the rejection and allow the graft to survive.

Advanced surgical techniques and immuno suppressant medication have increased the success rate of kidney transplantations in children. In addition, mental support and proper care can help a child in his recovery. With the right care, we can ensure our children stay healthy.

About the expert:

Written by Dr Saumil Gaur on 14 December 2017 and updated on 3 September 2019

The expert is MD FPN, Consultant Pediatric & Transplant Nephrologist at a leading children’s hospital.

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