Kidney Transplant

If your child has end-stage kidney (or “renal”) disease (when kidney damage is severe and the kidneys are failing) our caring, highly skilled, and experienced Solid Organ Transplant team can offer the hope of a transplant.

With more than two decades of experience and numerous successful transplants our Solid Organ Transplant team oversees one of the largest pediatric liver and kidney transplant programs in the country.

At Nemours/Alfred I. duPont Hospital for Children (AIDHC) we’re by your side from the start – providing ongoing support and care throughout the evaluation process and during treatment while you wait for a donor – as well as long after the transplant.

And all of our kidney transplant patients don’t just survive, they thrive in the months and years after the surgery. But our real success is measured by the hundreds of successful transplants we’ve performed – and all of the children who go on to lead normal, happy, healthy lives after their transplant. Seeing the kids we treat improve and thrive as they grow is the highest honor for what we do.

When the Kidneys Fail

The kidneys play a critical role in the body: Acting as the body’s filtering system, they help control water levels and eliminate wastes through urine, as well as regulate blood pressure, red blood cell production, and the levels of calcium and minerals. Kidney failure (also called “renal failure”) is when the kidneys slow down or stop filtering blood effectively, causing waste products and toxic substances to build up in the blood.

Kidney failure can be:

• acute(which means sudden and sometimes temporary), which may be due to bacterial infection, injury, shock, heart failure, or drug overdose
• chronic (occurring over time and usually long-lasting or permanent). In kids and teens, it can result from acute kidney failure that fails to improve, birth defects, chronic kidney diseases, or chronic severe high blood pressure. If diagnosed early, chronic kidney failure can be treated. But the child will usually require a kidney transplant at some point in the future.

The first successful kidney transplantation anywhere was in the early 1960s. Ever since then, a series of evolutionary improvements in the surgical technique and anti-rejection medications made this form of treatment more and more possible and acceptable for patients with end-stage kidney disease. Today, there are very few pediatric patients who would not be considered as candidates for kidney (renal) transplantation.

Renal Diseases Leading to Dialysis and Transplantation

A large ongoing study called the North American Pediatric Renal Transplant Cooperative Study (NAPRTCS) is designed to monitor long-term trends in the development of renal disease and changes in the management of patients with end-stage renal disease. According to the most recent statistics from this large database, the majority of children end up in renal failure and in need of a transplant from the following causes:

• Underdevelopment of the kidneys (renal dysplasia and hypoplasia) – when (for unknown reasons) a baby is born with less kidney tissue or the existing kidney tissue doesn’t function normally
• Glomerulonephritis (an inflammatory process within the kidneys) – which affects the glomeruli (small structures in the kidneys that supply blood flow to the filtering part of the kidneys)
• Focal segmental glomerulosclerosis – in which scar tissue forms in the glomeruli and protein leaks into the urine; some cases don’t improve with medication and require transplantation
• Obstruction (blockage) of the urinary collecting system – when the blockage of the urine flow damages the kidneys and can occur while the fetus is still in the mother’s womb

Types of Kidney Donors

Your child may be able to get a donated kidney in one of two ways – from a:

• living donor – either a relative (this is called a “living related donor”) or another unrelated person who the care team determines is a good match.
• deceased (or cadaver) donor – the most common way, donated by a healthy adult or child who became critically ill and died of this illness (after the person or his or her guardians agreed to donate the organs in the event of a sudden death). 

Our transplant team members perform living-related donor procedures whenever possible. Of course, not every child can get a living donor, but this technique does make it possible for more children to receive a kidney transplant as soon as possible – and increases their chances of long-term survival after the transplant. If there’s no willing and compatible living donor your child will be waiting until a kidney becomes available from the local and national organ donor waiting lists.

How a Kidney Transplant Works

Once your child gets the team’s OK after all of the required  tests and consultations (see Solid Organ Transplant for more information) and a deceased or living donor match is found, your child is ready for the transplant surgery. Your child will only need one donor kidney, which can take over the function of both failing kidneys.

For the transplant, your child’s original kidneys are usually left in place – except in rare cases where they’re removed because they’re too large from disease or they’re wasting protein.

The transplanted kidney may either start to work immediately or it may take a few days to get up to speed.

Patients who’ve had kidney transplants will need to be admitted directly to our Pediatric Intensive Care Unit from the operating room. Here, they’ll be monitored carefully during the first few days after surgery. Children can usually eat again in a few days and begin to resume some normal activity soon after.

And most kidney transplant patients do well and can function like normal kids. Our Solid Organ Transplant team members will work with you and your child not just right after you’re able to go home – but for the long-term, to make sure your child is healthy now and far into the future.