A kidney transplant is a surgery to put a new, healthy kidney into a person (recipient) whose kidneys are diseased and have stopped working, a condition called end stage renal disease. The diseased kidneys may or may not be removed before or at the time of the transplant.
A new kidney can come from another person deemed a donor whose blood type has to match the recipient, although not necessarily exactly the same. There are two types of donors:
- Living donor – A living donor is usually a family member or friend. He or she can be related to your child, but doesn't need to be. A living donor can also be someone you don't know, as an altruistic donor willing to give the gift of life to people who need transplant. This is not as common.
- Dead or decreased donor whose kidneys are otherwise healthy.
Getting a new kidney from a living donor is almost always better than getting a kidney from a deceased donor. The surgery is planned ahead of time when both the donor and child are in better condition at the time of the transplant. In general, the kidney from a living donor is healthier than the one from a deceased donor. Children can get a new kidney before their own kidneys stop working completely.
Comprehensive Kidney Transplant Program
The Upstate Kidney Transplant Program offers comprehensive kidney transplant services in the upstate area. Surgeons at Upstate routinely perform kidney transplants for children with end stage renal disease. Before receiving a kidney transplant, children need to meet the entire transplant team including nephrologists and transplant surgeons, nurses, dietitians, social workers, and transplant coordinators. In addition to blood tests and urine tests (if applicable), imaging studies are routinely requested for both the recipient and donor. A living donor also needs to come in person to be evaluated by the transplant team. A living donor has to be very healthy so his or her own life expectancy is not compromised. After careful evaluation, children without a suitable living donor may be cleared for a decreased donor. Waiting time for a deceased donor varies and could be years because of the overall scarcity of donors available compared to people who need a transplant.
Benefits of Transplant
The benefits of renal transplantation include freedom from dialysis and the time required for dialysis treatment, increased energy, removal of dietary restrictions, and overall better quality of life with increased life expectancy.
Risks of Transplant
The risk of infection is increased in kidney transplant children due to immunosuppression. This is necessary to help prevent kidney rejection. We routinely monitor for certain viral infection posttransplant and perform regular clinical examinations to look for signs of infection.
There is increased risk of cancer after transplant due to immunosuppression.
Certain kidney diseases may recur to the newly transplanted kidney. However, children with primary kidney disease due to congenital defect do not have recurrence of the same condition.
In addition to the risks above, posttransplant treatment includes taking 10 to 12 medications immediately after transplant. This number decreases over time further out from transplant. Usually, children will require 3 to 4 medications for maintenance for the rest of their life. Initially, children will require frequent followup posttransplant and blood work at least twice a week in the beginning and interval time between the followup appointments will increase further out from transplant.
In most of cases, children do well after transplant. It is possible, however, that the new kidney will not work at all or may be delayed in function. The average lifespan of a deceased donor kidney is around 10 to 12 years and of a living donor kidney around 15 years.
In spite of using immunosuppressive medications, it is still possible that transplant rejection may occur. That is because the body recognizes the new kidney as a foreigner and starts to attack it. Rejection can happen any time after a kidney transplant. It happens less often when the new kidney is from a living donor than when the new kidney is from a dead donor. Rejection is determined by a biopsy of the transplanted kidney. The rejection risk is high during the first year after transplantation and if this occurs, children would require more intensive immunosuppressive therapy at that time. Acute rejection is a serious problem. Children may lose their new kidneys from rejection. This will make a second kidney transplant much more difficult.
One of the major causes of transplant kidney failure is noncompliance with the immunosuppressive medications and inconsistency with followup. Taking medications on time and everyday and not missing any doses, as well as keeping the followup appointments, are extremely important to ensure the new kidney lasts as long as possible.
For more information, please visit Upstate Transplant Services.