Kidney Transplant - Paediatric
Narayan Health’s Paediatric Kidney Transplantation Program ranks among India’s top kidney transplant programs dedicated to children. Our multidisciplinary team of paediatric nephrologists, transplant surgeons, transplant coordinators, pharmacists, nurses, dietitians, and staff provides your children with the most comprehensive care possible.
Paediatric Kidney transplant
It is a general thought in society that a kidney transplant is not an option in children and finding a suitable donor for a kidney is not possible. Current medical advancements have made kidney transplant a reality in children who are over 15 kg of weight and above 4 years of age. Surgical procedures that are taken care at Narayana Health include-
- Paediatric Kidney Transplantation
- Pyeloplasty, Ureteric Re-implantation
- PUV Fulguration
- Augmentation Cystoplasty
Cadaveric Kidney Transplant
Cadaveric Kidney Transplant is suitable for children who do not have a medically fit donor and is also a good option considering a better quality of life after transplant than being on dialysis.
At Narayana Health, we have a team of well trained paediatric kidney transplant surgeons with extensive experience to manage kidney transplantation procedures in small children as per the Human Organ Transplantation Act. Our aim at Narayana Health is to provide children who have been diagnosed with kidney failure and are either on dialysis or without dialysis, a new lease of life with kidney transplantation and give them a normal childhood where they grow into healthy adults and fulfil their dreams.
Cadaveric kidney transplant means a kidney received from a deceased donor. Uniform Anatomical Gift Act allows anyone to donate organs for transplantation after death. Donors are carefully studied to prevent any mode of disease transmission.
If your child is eligible for a cadaveric kidney transplant and you choose to go through with this procedure, you will be placed in a waiting list amongst other patients. A sample of blood for antibody testing will be sent to the center. The waiting period will depend on the availability of the compatible kidney. As soon as a kidney compatible with your blood type and antibody level screens, you will have to report at the center for the surgical procedure immediately.
A transplant team service will verify that no medical issues or physical incompatibility interfere with the transplant through a few final tests before the surgery.
Overall results of pediatric renal transplantation from living donors are tremendous. Deceased donor organs are the primary source of donated kidney for renal surgeries in both children and adults. Since living donations can cause substantial financial impact and in long term outcomes does not prove to be fruitful as such, cadaveric contributions are increasing day by day. Expanding the donor bank may be accomplished by reassessing sources that are currently avoided, such as donation after cardiac death and infant kidneys transplanted at once.
Pediatric nephrologists must balance the waiting for the best quality and most compatible kidney against the need for the shortest possible waiting time.
When a kidney is available, UNOS decides the recipient based on different factors like:
- age of the recipient
- the blood type of the donor and recipient
- size of the donor's kidney in comparison to the body of the child
- the urgency of the child’s medical condition
- the waiting period of the recipient
- distance between the donor and recipient
You will have to stay in contact with your medical staff, health care team, and doctors at all times if you choose to receive your child’s donated kidney from a deceased person. Keeping a pager or having an emergency alert protocol connected to the hospital would be the best way to be vigilant and ready.
After locating a compatible kidney, you will be needed at the transplant center at a moment’s notice. So make sure the hospital and doctors can reach you at all times. Also, you can go through the medical details of the other patient to understand if he or she has any health complications or not. You need to go through the medical reports so that you can be assured that after the transplant is completed, you are free from any health complications.
While you wait for a transplant, keep your child as healthy as possible so that he or she is ready for transplant surgery when the time comes by ensuring the following:
- Strict diet recommendations from the dietitian
- Take all medicines as directed
- Attend all regular checkup
Pediatric Kidney Transplant
Kidney transplants are recommended for children above 15 kg of weight and four years of age who have severe renal problems and would not survive without dialysis or a transplant. Children with renal defects from birth or genetic inheritance. Some of the renal diseases that may require a kidney transplant in children are:
- Congenital disabilities and genetically inherited diseases which leads to kidney failure in children from birth to age 4.
- Hereditary disorders and nephrotic diseases are the most common cause of renal failure among children aged between 5 and 15.
- Conditions affecting blood vessels in renal tubules in kidneys cause kidney failure in children of ages 15 to 19.
In some cases, children with the above complexions might not require a renal transplant. Consult your child’s healthcare service for a diagnosis.
One might receive transplantable and compatible kidneys from either a deceased donor or a living person.A kidney transplant is possible with a donated kidney from an adult or child. A child above two years can well fit an adult kidney in its body cavity.
At the kidney transplant center, your child will have to go through various tests to help evaluate the compatibility of a successful kidney transplant. This is a team of medical health experts who will decide if the child is a suitable candidate for renal surgery. The transplant center team involves a group of transplant surgeons, nephrologists, urologists, medical advisors, and dietitians who will ensure the good health of your child.
The extensive transplant evaluation before the procedure will include blood tests, diagnosis, psychological tests. These tests help understand the condition of the child and further ensure that your child receives the ideal donor and perfect treatment.
Once a compatible donated kidney is available, the surgical procedure will immediately start. A few final antibody tests and match tests are performed. The surgery might take a few several hours depending on the individual cases.
Pyeloplasty, Ureteric Reimplantation
Pyeloplasty is the surgical set up of the renal pelvis to drain and constrict the kidney. Most cases of pyeloplasty surgery are to free a ureteropelvic junction blockage. Obstruction in the kidney and ureter region, specifically in the renal pelvis and ureter, leads to complexions. This is called UPJ obstruction. An ultrasound and kidney scan verifies this blockage. The abnormal growth in the tube connection is removed surgically, and the ureter is repositioned and attached to the kidney to clear out the affected section. The duration of operation will take up to two to three hours.
It might take a few days to observe the child’s health and discharge accordingly. Children who have successfully gone through with pyeloplasty surgery may be affected by urinary tract infections.
Ureteric Reimplantation requires critical incision and dissection in the abdomen. When there is an obstruction in the lower region of the ureter where it connects with the bladder, this procedure is taken into consideration. The distal portion of the ureter is cleared of the blockage through a simple cut and stitch method. The doctor will cut the ureter that is present above the other obstructions and will reimplant the parts that are unblocked within the ureter, inserting it in the bladders ending. They will make a new opening within the bladder and attach the other end of the ureter to the opening.
According to the child’s health and age, this procedure will be advised. In most cases of such renal blockage, surgery is necessary. Your child’s healthcare provider will suggest an insight into the process.
PUV Fulguration
Posterior urethral valves (PUV) are membranes that form around the urethra (tube draining urine from the bladder), near the bladder region. This valve can block or stop the flow of urinary waste through the urethra. This leads to dilation and further damage.
PUV treatment is based on different aspects of a child’s health and a situation like:
- age, health, genetic history, and medical conditions
- abnormality in the functionality of the kidney
- tolerance for specific medications, surgical procedures, and other physiological factors
PUV surgery depends on how severe the condition is for the child. During primary diagnosis, almost all patients undergo surgical procedures to remove the valve, which initially causes the blockage. A cystoscope i.e., a small telescope with a camera, is inserted into the urethra and examined. Through surgery, the membrane is cut such that it does not obstruct the flow of urine from the bladder to the urethra.
In a few cases, a child might need more severe incisions to let their urine flow and empty fully through a vesicostomy by the use of a catheter. A vesicostomy is an opening surgically formed in the bladder through the abdominal cavity using an incision to allow the flow of urine out of the bladder. This opening is closed later when the child is more mature and has improved urinary functions.
Catheters might be needed regularly to empty the child's bladder.
Severe medications may be used in some patients to relax bladder muscles and prevent infections after the procedure. Your child’s healthcare and the doctor will suggest the appropriate medicines for this purpose.
Augmentation Cystoplasty
Augmentation cystoplasty is a surgery involving an incision made by a surgeon in the abdomen of the patient to help enlarge the bladder.
Cystoplasty is a preferred choice for children with end-stage renal functionality failures and bladder dysfunctioning. Patients with high blood pressure and low bladder capacity can pose risks for renal surgeries. Cystoplasty can help protect the kidney structure by reducing the vascular pressures and providing appropriate bladder capacity.
Augmentation cystoplasty in children who lack adequate detrusor compliance may prove to be a needful surgery that provides a secure, functional reserve that allows for urinary moderation and prevention of upper tract infections.
General anesthesia is given to your child to keep him asleep through the operation. The surgery takes more or less 3 hours, depending upon the age and condition of the patient.
Augmentation cystoplasty is a safe and secure effective process of improving lower urinary tract function in the pediatric renal transplant in children with a small bladder capacity.
Kidney Transplant - Paediatric FAQs
When is a kidney transplant recommended for children?
A kidney transplant is necessary when the child has serious kidney problems and won’t survive without dialysis or a transplant. Some of the kidney diseases in children that may require a kidney transplant are mentioned below:
- Congenital disorders and hereditary diseases are the most common factors that cause kidney failure in children from their birth to age four.
- Kidney failure in children in the age group of five to fifteen years is caused by hereditary diseases, systemic disease and nephrotic syndrome.
- In children between the ages of fifteen and nineteen, the most common cause of kidney failure are the diseases that affect the blood vessels in the kidneys.
It is not mandatory that children with these diseases will need a kidney transplant. Hence, a thorough diagnosis from a healthcare professional is recommended.
Where does the transplanted organ come from?
The transplanted organ comes from two types of donors: deceased donors and living donors.
Deceased donors: Most of the transplanted kidneys come from deceased donors. The organ donors are adults or children who may have agreed to be an organ donor before becoming ill. The family of the deceased person must agree to donate the organs as well.
Living donors: The donor kidney can also come from family members or people who are a good match. They can safely donate one kidney and live a healthy life with the other one. It is possible for a child older than two years to receive an adult kidney.
How is a child placed on the waiting list for a new kidney?
After you visit a transplant centre, the health care team will check whether your child is healthy enough for the kidney transplant surgery through blood tests, X-rays and other tests. Once the transplant teams come to the conclusion that your child can receive the transplant, the next step is to find a kidney. A family member or a close relative with the compatible blood type can donate the kidney.
In case a living donor isn’t available, the child’s name is put on a waiting list until a kidney from a deceased donor matches your child. This can take a long time as the need for kidneys is far more than the number of kidneys donated. Until then, you will have to stay in touch with the transplant team and the doctors.
What happens after a kidney transplant?
After the transplant, the child has to be in observation for a few days or a week in the hospital and recover. The health care team will make sure that the surgery doesn’t result in any complications, such as bleeding or infection.
To prevent the body from rejecting the new kidney, the child has to take immunosuppressants. The child is susceptible to get infections in the days right after the surgery. So, care must be taken.
Follow up visits for the first couple of months after surgery is important. During the visits, the doctor will ensure whether the new kidney is working well. Besides, if you notice any soreness in the area of the transplant, you have to inform the doctor right away.
