Kidney Transplantation in Children

Kidney Transplantation is surgery to replace one of your child’s kidneys with a kidney from another person (donor kidney). Your child may need a kidney transplant if no other treatment can restore health to the kidneys.

Kidney transplant is a major surgery. You and your child will work with a team of health care providers (transplant team) to help your child prepare for the procedure and recover.

A donor kidney may come from a living person, or it may come from someone who has died and donated his or her kidney. Your child may be put on a waiting list for the donation and may get treatment with an artificial kidney (dialysis) during this time.

Tell a health care provider about:

• Any allergies your child has.
• All medicines your child is taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Previous problems your child or family members have had with anesthetic medicines.
• Any surgeries your child has had.
• Any medical conditions your child has.
• Any blood disorders your child has.

What are the risks?

This is a major surgery. Problems may occur, such as:

• High blood pressure.
• Infection.
• Bleeding.
• Your child’s disease-fighting system (immune system) attacking the new kidney. This is called rejection.
• Blood clots in the blood vessels of the new kidney.
• Narrowing of the blood vessels of the new kidney.
• Fluid buildup around the new kidney.
• Urine blockage or leaking where the new kidney attaches to the bladder.
• Damage to other structures or organs.
• Emotional problems and stress caused by the long recovery and the need to limit contact with other people after the procedure.
• Problems caused by medicines, such as allergic reaction or a higher risk of:
  • Infections.
  • Diabetes.
  • Certain types of cancer.
  • Bone thinning (osteoporosis).

What happens before the procedure?

Medicines

Ask your child’s health care provider about:

• Changing or stopping your child’s regular medicines. This is especially important if your child is taking diabetes medicines or blood thinners.
• Giving your child medicines such as aspirin and ibuprofen. These medicines can thin the blood. Do not give your child these medicines unless your child’s health care provider tells you to do that.
• Giving your child over-the-counter medicines, vitamins, herbs, and supplements.

Staying hydrated

Follow instructions from your child’s health care provider about hydration, which may include:

• Up to 2 hours before the procedure – your child may continue to drink clear liquids, such as water or clear fruit juice.

Eating and drinking restrictions

Follow instructions from your child’s health care provider about eating and drinking, which may include:

• 8 hours before the procedure – have your child stop eating foods.
• 6 hours before the procedure – have your child stop drinking formula or milk.
• 4 hours before the procedure – stop giving your child breast milk.
• 2 hours before the procedure – have your child stop drinking clear liquids.

General instructions

• Your child will have many tests, including blood tests and imaging tests.
• Ask your child’s health care provider how your child’s surgical site will be marked or identified.
• You and your child may need to plan for a long recovery time with limited activity. Your child may need psychological and emotional counseling to prepare for the procedure and the long recovery.

What happens during the procedure?

• Ask your child’s health care provider what steps will be taken to help prevent infection. These may include:
  • Washing your child’s skin with a germ-killing soap.
  • Antibiotic medicine.
• An IV will be inserted into one of your child’s veins.
• Your child will be given a medicine to make him or her fall asleep (general anesthetic). Your child may also be given a medicine to help him or her relax (sedative).
• A small, thin tube will be inserted into your child’s bladder to drain urine during and after surgery (urinary catheter).
• An incision will be made. Where exactly the kidney is placed depends on your child’s size:
  • Small children may have the new kidney placed in the middle part of the abdomen.
  • Larger children may have the new kidney placed in the lower abdomen, above the hip.
• The blood vessels of the new kidney will be sewn onto blood vessels inside the abdomen.
• The part of the body that drains urine from the new kidney to the bladder (ureter) will be sewn into the bladder.
• Usually, a child’s old kidneys will be left in their normal position. The old kidneys may be removed if they are enlarged due to cysts or if they cause problems such as high blood pressure or infections.
• A tube may be placed near the new kidney to drain excess fluids from the surgical area (surgical drain).
• Your child’s incision will be closed with stitches (sutures) or staples and covered with a bandage (dressing).

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

• Your child’s blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored until he or she leaves the hospital.
• Your child may breathe through a tube in his or her throat. While this breathing tube is in place, your child will be given medicine that keeps him or her asleep (sedated). If there are no early signs of bleeding or rejection, the breathing tube will be removed.
• Your child may continue to have:
  • An IV providing nutrition and fluids. This may be removed after a few days, when your child can start eating a normal diet.
  • A urinary catheter.
  • Surgical drains.
• Your child will be given medicines that help:
  • Relieve pain.
  • Prevent rejection of the new kidney.
• Your child may have to wear compression stockings. These stockings help to prevent blood clots and reduce swelling in the legs.

Summary

• Kidney transplant is a major surgery. A transplant team will help you and your child prepare for the procedure and help your child recover.
• This procedure is done with general anesthesia. This means that your child will be asleep during the procedure. Your child may continue to be asleep (sedated) for a period of time after the procedure.
• A risk of this procedure is that your child’s body may reject the donor kidney. Your child will be monitored closely for symptoms of rejection.

Care After Kidney Transplantation in Children

This sheet gives you information about how to care for your child after your child’s procedure. Your child’s health care provider may also give you more specific instructions. If you have problems or questions, contact your child’s health care provider.

What can I expect after the procedure?

After this procedure, it is common for children to have:

• Soreness in the side or abdomen.
• Fatigue.
• A weak disease-fighting system (immune system).
• Changes in mood.

Follow these instructions at home:

You and your child will need to work closely with a team of health care providers (transplant team). You and your child should learn as much as you can about your child’s condition so that you have an active role in treatment and recovery.

Watching for rejection

Rejection means that the immune system is attacking the new kidney. This is most common during the first few months after surgery. If your child has changes in certain body measurements or has certain signs or symptoms, he or she may be having a rejection response.

• Take the following measurements every day. Ask your health care provider how to measure your child’s:
  • Temperature.
  • Blood pressure.
  • Fluid intake.
  • Urine output.
• Watch your child for any of the following signs or symptoms of possible rejection:
  • Fever.
  • Muscle aches.
  • Abdominal or side pain.
  • Decreased urine output.
  • Sudden weight gain.

Medicines

• Give your child over-the-counter and prescription medicines only as told by your child’s health care provider. Do not stop giving any of these medicines to your child unless your child’s health care provider tells you to do that.
• Ask your child’s health care provider what side effects you should be aware of.
• Develop a routine to make sure your child takes all medicines correctly and at the right time each day.
• Do not give your child aspirin because of the association with Reye syndrome.

Eating and drinking

• Work with a nutrition specialist to make sure that your child eats enough calories and healthy foods, including proteins and minerals.
• Follow instructions from your child’s health care provider about:
  • Whether your child needs to take supplements or vitamins.
  • Diet restrictions. Your child may need to limit salt.
• Have your child drink enough fluids to keep his or her urine pale yellow.
• Do not let your child eat raw or undercooked foods. Those foods raise the risk of infection. Make sure that all the food your child eats is cooked completely or safe to eat.

Bathing

• Do not let your child take baths, swim, or use a hot tub until your child’s health care provider approves. Ask your child’s health care provider if your child may take showers. Your child may only be allowed to take sponge baths.

Incision care

• Follow instructions from your child’s health care provider about how to take care of your child’s incision. Make sure you:
  • Wash your hands with soap and water before you change your child’s bandage (dressing). If soap and water are not available, use hand sanitizer.
  • Change your child’s dressing as told by your child’s health care provider.
  • Leave stitches (sutures), skin glue, or adhesive strips in place. These skin closures may need to stay in place for 2 weeks or longer. If adhesive strip edges start to loosen and curl up, you may trim the loose edges. Do not remove adhesive strips completely unless your child’s health care provider tells you to do that.
• Check your child’s incision area every day for signs of infection. Check for:
  • Redness, swelling, or pain.
  • Fluid or blood.
  • Warmth.
  • Pus or a bad smell.

Activity

• Ask your child’s health care provider what activities are safe and what activities your child should avoid. Your child may be able to return to normal activities gradually over several weeks.
• Do not allow your child to do any of the following until his or her health care provider approves:
  • Lift anything that is heavier than 10 lb (4.5 kg), or the limit that your child’s health care provider tells you.
  • Travel far from the hospital, clinic, or transplant center.
  • Drive or use heavy machinery, if applicable.

Preventing infection

• Certain medicines that your child takes may raise his or her risk of infection. Make sure that your child:
  • Washes his or her hands frequently with soap and water. If soap and water are not available, use hand sanitizer. You should also wash your hands frequently, as should other caregivers.
  • Avoids close contact with people who are sick.
• Ask your child’s health care provider when your child can get vaccines and flu shots and which vaccines are safe for your child.

Sun protection

• Protect your child from the sun. This includes having your child:
  • Wear sunscreen, for children 6 months and older. Ask your child’s health care provider which sunscreen is safe for your child.
  • Avoid outdoor activities when the sun is strongest (between 10 a.m. and 4 p.m.).
  • Wear a wide-brimmed hat and sunglasses.

General instructions

• Have your child wear compression stockings as told by his or her health care provider. These stockings help to prevent blood clots and reduce swelling in the legs.
• Talk with your child’s health care provider if your child is having any emotional problems during recovery, such as sadness, stress, or anxiety.
• Protect your child from smoking and alcohol.
• Keep all follow-up visits as told by your child’s health care provider. This is important. Your child will need to return to the hospital, clinic, or transplant center often to have:
  • Blood tests.
  • Kidney function tests.
  • Kidney imaging tests.

Contact a health care provider if your child has:

• Signs of infection at the incision site.
• Side effects from medicines.
• Chills or a fever.
• Any changes in:
  • Temperature.
  • Blood pressure.
  • Urine output.
• Sudden weight gain.
• Symptoms of an infection, such as:
  • Cough.
  • Nasal stuffiness (congestion).
  • Sore throat.
  • Diarrhea.
  • Sores on the skin or in the mouth.
  • Burning pain while urinating.

Get help right away if your child:

• Has a sudden decrease in urine production.
• Has any signs or symptoms of possible rejection.
• Has difficulty breathing.
• Becomes extremely tired or sleepy.
• Becomes unresponsive.

Summary

• You and your child will need to work closely with the transplant team during recovery. It is important for you and your child to have an active role in recovery and treatment.
• Stay close to your child’s hospital, clinic, or transplant center. Your child will need to return often to have follow-up tests.
• Make sure that you know when to call your child’s health care provider and when to call emergency services.