In today’s age, medical advancements in surgical techniques and rising technology 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 with advanced technologies and efficient paediatric nephrologists, who are legally authorized to perform such surgeries in children.
Generally, parents become worried or confused when they are told that their child needs to undergo kidney transplantation. In addition to their worry, there will be their limited awareness of the condition and the treatment facilities available while choosing the hospital. It is important to note that the appropriate doctor to organize kidney transplant in children is a Paediatric Nephrologist and not adult nephrologist as there is a difference between child and adult physiology. This is an important piece of information most parents are unaware of.
Causes of kidney failure:
The most common causes of kidney failure in youngsters range from genetic diseases like congenital anomalies of kidneys in which there is an aberrant formation of kidneys in uterus 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:
Once the kidneys have failed, the options for survival are limited as the blood purification process halts. In such a situation, purification is done using dialysis.
Dialysis is a process that is used to filter and purify 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 of time compromises the quality of life. Hence, it is recommended that early kidney transplant should be performed in children to improve the quality of life.
Normally, kidney transplantation is required when the function of the kidney is low enough to sustain the purification of blood and this usually happens when the function of kidney falls below 10-15 per cent of normal.
Any child who is more than 10-12 kgs 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 able dedicated paediatric kidney transplant team led by a well-qualified and able Paediatric Nephrologist.
Two types of kidney transplants:
- Living donor transplant: As the name suggests, with 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, 1st 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.
- Nonliving–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 cross-match 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 to sleep throughout. The new kidney will be placed in the abdomen and the surgeon will attach the kidney's blood vessels to 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 to complete. Once the process is done with, it will start working right after the surgery, or a few weeks.
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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 recognize a new kidney as a foreign object and attempt to reject it. Lifelong anti-rejection medications could help the child to overcome the state and allow the graft to survive.
Advanced surgical techniques and immune suppressant medications have combined to keep the success rate of kidney transplantations in children to a higher extent.
In addition, mental support and proper care can help a child recover fast. With the right care, we can ensure our children’s smiles are safe.
The author is MD FPN, Consultant Pediatric & Transplant Nephrologist, Rainbow Children’s Hospital.
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