Pediatric Kidney Transplant

As the kidneys become more diseased, they gradually lose their ability to function, a condition called end stage renal disease (ESRD). The treatments for renal failure are hemodialysis, a mechanical process of cleaning the blood of waste products; peritoneal dialysis, in which toxins are removed by passing chemical solutions through the abdomen; and kidney transplantation.

None of these options cures renal failure. However, transplantation offers the closest thing to a normal state if the transplanted kidney can replace the failed kidneys.

Kidneys for transplantation come from either a living donor or a cadaver. When a living person donates a kidney, his or her remaining kidney will enlarge as it takes over the work of two kidneys. Donors don't need medication or special diets once they recover from surgery. As with any major operation, there is a chance of complications but kidney donors have the same life expectancy, general health, kidney function and activities as most other people. The kidney loss doesn't interfere with a woman's ability to have children. Potential donors whose jobs require extreme physical exertion need to discuss this with the transplant staff.

Any healthy person can donate a kidney safely. Sometimes a family member or close friend may wish to donate a kidney. He or she must be in excellent health, well informed about transplantation, and able to give informed consent.

The initial costs for living donor surgery, hospitalization, diagnostic tests and evaluation are usually paid by the recipient's insurance. Travel and living expenses are not covered. Insurance coverage will be discussed at the time of your transplant evaluation.

If you have a potential living donor, he or she will meet with a transplant physician and a transplant coordinator during the evaluation process to discuss the possibility of organ donation. Tissue typing and other tests will be performed to determine the potential donor's suitability. In some families, several people may be compatible donors. In other families, none of the relatives or non-relatives may be suitable.

In the past, most donors have undergone an open surgical procedure requiring a large incision in to remove the donor kidney, which usually resulted in a two-month recovery period. A new procedure, called laparoscopic donor nephrectomy, uses tiny incisions and miniature instruments to remove the kidney. We offer the laparoscopic procedure through a cooperative program involving transplant surgeon Dr. Chris Freise, general laparoscopic surgeon Dr. Quan-yang Duh and urologic surgeon Dr. Marshall Stoller. Approximately 60 procedures have been performed at UCSF Medical Center since November 1999.

Only left kidneys are removed with this procedure, due to considerations of blood vessel length. Most laparoscopic nephrectomy patients require an inpatient stay of only two or three days, compared to four or five days for a conventional open nephrectomy. In our experience, the laparascopic procedure is just as safe for both donor and kidney recipient, and recovery was easier for the donor. Laparoscopic nephrectomy is now offered to any patient with suitable anatomy. The ultimate impact on live donor transplant rates at the medical center remains to be seen, but other centers have seen live donor rates increase markedly which could decrease the demand and waiting time for cadaver kidneys.

A cadaveric kidney comes from a person who has suffered brain death. All donors are carefully screened to prevent any disease transmission. The Uniform Anatomical Gift Act allows all of us to consent to organ donation for transplantation when we die and allows our families to provide such permission as well. After permission for donation is granted, the kidneys are removed and stored until a recipient has been selected.

If you want your child to undergo a cadaveric kidney transplant and he or she is medically acceptable, his or her name will be placed on a cadaver waiting list. A sample of blood for antibody level is sent monthly to the medical center. The waiting period for a cadaver kidney depends upon the availability of a cadaver donor compatible with your blood type and your antibody level.

When a kidney becomes available, your referring kidney specialist is contacted for medical approval. The transplant service will verify that you have no recent infections or medical problems that would interfere with safe transplantation. The transplant service will tell you when a cadaver kidney is available and will assist in making arrangements for your transplantation.

Your child's surgery may last from two to four hours. During the operation, the kidney is placed in the pelvis rather than the usual kidney location in the back. Your child's own native kidney will remain undisturbed. The artery that carries blood to the kidney and the vein that removes blood from it are surgically connected to two blood vessels already existing in the pelvis. The ureter, or tube that carries urine from the kidney to the bladder, is also transplanted through an incision in the bladder.

After the operation, your child will be taken to the recovery room for a few hours and then will return to the Kidney Transplant Unit. The surgeon will inform you when the procedure is over.

Your child will be encouraged to get out of bed starting 12 to 24 hours following surgery and to walk around the Kidney Transplant Unit as much as he or she can. Nurses will help teach him or her how to take medications and about side effects and making lifestyle changes.

A cadaver kidney transplant will occasionally perform as a "sleepy" kidney, a condition called acute tubular necrosis (ATN). This means that the kidney is temporarily slow in functioning because of being stored. Your child may need dialysis a few times, which will not harm the kidney. The "sleepy" kidney usually starts working in two to four weeks.