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Guidelines for sites linking to mayoclinic.orgKidney transplantation involves more than simply an operation. Preparation and evaluation, waiting for transplant and recovery following surgery are all part of a long journey for the transplant candidate and family. Even after full recovery, some lifestyle changes are necessary for continued health after transplantation.
Transplant evaluation
Initially, kidney transplant candidates need to undergo an evaluation and consultation consult with a pediatric nephrologist (kidney specialist) to determine whether transplantation is likely to be a safe and beneficial treatment option. Referring physicians can also consult directly with our staff by calling Mayo Clinic's Referring Physicians Service.
At Mayo Clinic a multi-disciplinary cares for children with chronic kidney failure. The team includes physicians, nurses, social workers, dietitians, child psychiatrists, and a transplant surgeon.
The transplant team monitors each child's medical status closely and verifies that all immunizations are up to date before a transplant. Once the team determines that a child is eligible for a transplant, the search for a potential donor begins.
This pre-transplant evaluation commonly includes the following elements:
Once a child is approved for kidney transplantation, a pediatric nephrologist will determine how often medical examinations are needed during the waiting period before surgery. Medications and diet changes may be necessary to help correct abnormalities found during the transplant evaluation. Following these guidelines helps ensure that the child is as healthy as possible before transplantation occurs.
Keeping in touch
While a child waits for a cadaver kidney transplant, it is important to remain in close contact with the transplant team. Because the transplant team may need to reach a candidate's family at any time of the day or night, we will ask for home and work phone numbers. Once a cadaver kidney becomes available, the child must come to Rochester as quickly as possible, usually within eight hours of notification.
If a child becomes ill
If the child becomes ill while waiting for transplant surgery, notify the pediatric nephrology transplant coordinator or the pediatric nephrologist immediately. Depending on the severity of the illness, transplant surgery may need to be postponed until the child is healthy enough to tolerate surgery.
Living donor vs. cadaver kidney transplants
There are two types of kidney transplants: a living donor kidney transplant and a cadaver kidney transplant. A pediatric nephrologist and a transplant surgeon will discuss both types of kidney transplants with the family to help determine which approach is more suitable for their situation.
In a living-donor transplant, an adult (18 or older) gives one kidney to the child. The donor can be either a family member or someone unrelated, such as an adult family friend. Living donors can continue to lead a healthy and normal life with their one remaining healthy kidney.
These types of transplants can be scheduled to best suit issues of health, school and convenience for both the donor and recipient. Of the more than 12,000 kidney transplants performed in the United States during 1999, slightly more than one third were from living donors.
In a cadaver transplant, the child receives a kidney from a healthy person who has died suddenly. In this situation, the deceased person's family has agreed to donate the kidneys for transplantation. The physician caring for the deceased person and a transplant surgeon will determine whether the kidney is suitable for the transplant recipient. It is not possible to predict when a cadaver donor kidney will become available. Transplant candidates may wait for months or years for an opportunity to receive a cadaver kidney.
Additional testing before surgery
Transplant candidates should arrive a day or two before transplantation to undergo a physical examination by the pediatric nephrologist and some additional medical tests, including blood work, chest X-ray, urine test and an EKG. For a scheduled living donor transplant, the child is usually admitted to the hospital the evening before surgery. If the donor is a cadaver, the child needs to come directly to the Mayo Eugenio Litta Children's Hospital for testing.
What to bring to the hospital
At the time of transplantation, bring any medical equipment that your child uses, such as a blood pressure cuff/machine, any dialysis equipment and enough dialysis solution for one week. Also pack an assortment of comfortable, loose-fitting clothes for your child to wear after surgery, as well as slippers for use in the hospital. Favorite toys, stuffed animals, games, mylar balloons, and videos are always welcome. Latex balloons, fresh flowers and plants are not allowed in the hospital room.
The day of surgery can be very emotional. In some cases, when a parent donates a kidney to his or her child, the remaining parent is concerned for both the child and the donor. In this situation it is helpful to have a few other family members present to support and comfort to both the child and the donor. The donor's surgery takes place at Rochester Methodist Hospital, about 10 blocks away from the Mayo Eugenio Litta Children's Hospital. Patient and family shuttle service between the hospitals is available.
Transplant Operation
Kidney transplantation involves surgically placing another person's kidney (the donor) into a child's lower abdomen, usually on the lower right side. The transplanted kidney is placed in the pelvic area, not where the original kidneys are.
Surgeons usually attach the donor ureter (the tube through which urine flows) to the child's bladder, allowing urine from the new kidney to flow in the normal manner. The child's own kidneys are usually not removed. The transplant surgery typically takes about three hours. The donor kidney should begin to function immediately.
Following Surgery
Following transplant surgery, most children remain in the hospital for about one week. While hospitalized, the child will have a central line catheter in place for blood work and administering certain medications. A urinary catheter will also be in place for about five days. Daily blood tests will also be required.
During recovery, as the discomfort around the incision lessens, the child can move around more and gradually return normal activities. In most cases, the child can get out of bed and take short walks the day after surgery. Nurses will assist the child with daily walking and deep breathing exercises, which are an important part of the recovery period. Different members of the transplant team will also help the child and family members learn more details about the medications needed to prevent the transplanted kidney from rejection.
Because each individual's situation is unique, we can only address this important issue in the broadest terms here. During your visits with Mayo Clinic staff, you will have ample opportunity to discuss your specific situation with many experienced professionals.
After-hospital care in Rochester
Care at home
Resuming physical activities
Medications
After-hospital care in Rochester
Following dismissal from the hospital, the child must remain in Rochester for about four weeks. Transplant recipients need blood tests daily during the first week after hospital dismissal, and less frequently during the following weeks.
A pediatric nephrologist and the transplant coordinator will review the blood test results daily and, if necessary, they can make medication adjustments and answer specific questions patients and their families might have.
Before leaving Rochester, staff will meet with the child and family members to discuss the following:
Care at home
When the child leaves Rochester, family members will have instructions how to contact the Mayo Transplant Team with any questions. The Mayo Transplant Team will provide local physicians with a report of the child's transplant status and home-going instructions concerning the frequency of blood work, which is usually three times a week after the child leaves Rochester.
Resuming physical activities
Some children require a transition period to get back into full days of school, depending how fatigued they may feel. And children should resume participation in physical education classes gradually. But over time, most children should be able to participate in school, play sports, and feel energetic.
Medications
We expect all transplant recipients to need life-long treatment with immunosuppressant medicines to prevent rejection of the transplanted kidney. These medications must be taken daily following surgery.
Mayo's kidney transplant team will choose these medicines based on the child's personal medical history and our extensive experience in preventing and controlling transplant rejection. Some children do experience side effects from their medications, but we have excellent success in finding an acceptable treatment plan in most cases.
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