Solid Organ Transplantation

Solid Organ Transplantation services at Nemours includes comprehensive evaluation, treatment and ongoing care for children with end-stage liver and renal disease. Nemours physicians are specially trained and board-certified. They utilize the most up-to-date knowledge from universities worldwide as well as the latest medical technology. At Nemours, we provide excellent care that places the patient and family at the center, and our commitment to communication is central to the process. We strive to create a uniquely satisfying experience bringing peace of mind to patients and families.

At Nemours/Alfred I. duPont Hospital for Children, for example, our physicians oversee one of the nation’s largest pediatric liver transplant programs. The team devoted to this program has a long and successful history of working together using a multidisciplinary approach to patient service. This team has been involved in hundreds of transplant cases for a variety of liver diseases and associated complications. Living-related donor procedures allow living relatives to donate a segment of liver for transplantation. This technique makes it possible for more children to receive liver transplants in a timely manner. Thanks to living-related donor procedures the long-term survival of liver transplant patients has steadily improved with a one and five-year survival rate of greater than 90% and 82% respectively.

Our Team

Our transplant team consists of several parts that make a wonderful whole. We function as a group consisting of surgeons, physicians, and nurses. This team makes daily round on the patients and make decisions as a group in order to have a complete picture of the child's condition. This make-up of caregivers offers the patient the best evaluation of the entire condition from several view points with expertise in numerous areas all coming together to make a decision on patient care.

The Parts

Surgeon - The surgeons on the team both trained and boarded in pediatric surgery. They are dedicated to the surgical treatment of children. They have further training in pediatric transplantation and are now exclusively dedicated to pediatric transplantation. They participate in the surgical procedure as well as daily rounds on the patient. They are involved in all long-term decisions on the patients through weekly team meetings where all patients seen in outpatient clinics are discussed.

Pediatrician - The members of the diagnostic referral service of the AI duPont Hospital for Children also serve as members of the transplant team. Both physicians have had experience with the care of transplant patients. Their area of expertise is in the care of the complicated pediatric patient. Their insight into the long-term care of the transplant patient as well as immediate care around the time of transplantation is invaluable.

Gastroenterologist - The gastroenterologist offers expertise in the treatment and management of liver disease pre and post transplant. Our hepatologist offers the latest treatment of liver disease as well as management of liver disease prior to transplantation.

We also have a specialist in the treatment of intestinal failure. He provides insight into the management of medications and feedings pre and post transplant. He also provides technical assistance for patients needing endoscopic procedures as part of their evaluation or for biopsies after transplantation.

Nephrologist - The nephrologists are the main care givers of children with kidney disease. They manage patients before and during dialysis as well as after kidney transplantation. Together with the transplant surgeon, they round daily on the transplant patients and make decisions on patient care. They will be following children after transplantation on an outpatient basis.

Transplant Coordinators - Renal - Transplant Coordinators play an intricate role in the success of any Transplant Program. The role is multifaceted and requires critical thinking, problem solving, dedication and flexibility. In her role as the Renal Transplant Coordinator, she is typically involved as soon as a patient is close to being declared Near End Stage. At that time the team meets formally with the patient and their families to discuss options. Once a family has decided to pursue transplantation, plans are initiated to coordinate either a Living Related Transplant or listing the patient for a Cadaveric Kidney if a donor is not available. Workups are then arranged to ensure that potential donors and recipient are medically cleared for transplant. Patients are followed very closely post transplant both in the hospital and as outpatient once discharged. Extensive teaching is initiated prior to transplant that carries on post transplant on an ongoing basis. The signs and symptoms of rejection, infection and medication instruction are a major focus for the Coordinator.

Transplant Coordinators - Liver/Small Bowel - The transplant coordinator is the center of all activity. They are sometimes the first person you will meet when you are referred for evaluation. They are often the ones who will update you on information and will serve as your point of contact for the service. The transplant coordinators are highly trained nurses who are the support of the transplant team. They are involved with all aspects of the transplant from the time of referral and evaluation to the long-term care and follow-up of the patient. They will answer any questions you have about transplantation, including the evaluation process and placement of your child on the transplant waiting list.

The coordinator serves as the person responsible for

Coordinating the pre-operative evaluation of the patient in preparation for transplantation
Coordinating the evaluation of any possible living donor
Providing appropriate discharge teaching for patients and family
Providing psychosocial support to patients and family
Arranging for follow-up care including
Diagnostic tests
Laboratory studies
Outpatient therapies
Prescriptions
Follow-up appointments
Providing consultation to families and children through identification of appropriate community resources and existing networks of patient referral.

Statistics

Our transplant team moved to the Alfred I. duPont Hospital for Children from another facility. As a team we have performed over 250 pediatric liver transplants and 151 pediatric kidney transplants. We are a very active center, having performed more than 50 living-related liver transplants and 47 living-related kidney transplants. We would be happy to provide results of the entire experience of our team upon request.

Since our arrival at A.I. duPont Hospital for Children in July 2000, we have performed 59 liver transplants, 28 of which have been living-related, and 20 kidney transplants, 13 of which have been living-related. Living donation has become an effective way to address the current difficulty, experienced by all transplant programs around the country, in obtaining cadaver organs.

Liver Transplant	Patient Survival	Graft Survival
3 month	98%	98%
6 month	97%	97%
1 year	93%	90%
3 year	93%	90%
Kidney Transplant	Patient Survival	Graft Survival
3 month	100%	95%
6 month	100%	89%
1 year	100%	89%
3 year	100%	79%