Kidney Transplant

Selection of Children for Kidney Transplant

Kidney transplantation is a treatment option for children experiencing chronic kidney failure. The transplanted kidney can survive such an operation quite well, and usually will provide good function to the recipient for a long period of time.

Transplantation is the only option at present to replace normal kidney function. However, it is not a cure for kidney disease, because a life-long commitment must be made to care for the transplanted kidney through special medications, regular blood tests and other things as they are needed. Nevertheless, transplantation offers many an excellent alternative to dialysis treatments, offering good return of kidney function and an improved quality of daily life.

In children, kidney problems can result from:

• Congenital urinary tract or kidney disorders
• Inherited kidney disorders such as ARPKD
• Acquired kidney disorders such as FSGS
• Other diseases that can destroy the kidney such as vasculitis

In many cases, these disorders can be treated successfully for long periods with medications and/or surgery before transplantation is needed. But kidney failure in children can delay growth and cause chronic problems such as a lack of concentration, bleeding problems and decreased appetite and energy levels.

For these reasons, kidney transplantation is sometimes performed preemptively, before the child requires dialysis. In children, hemodialysis or peritoneal dialysis is usually considered only as a bridge to transplantation. But in certain instances, children may require dialysis treatments before transplantation.

Potential Benefits of Kidney Transplantation

Successful kidney transplantation can increase a child's energy level and provide an improved quality of life. Kidney transplantation also offers these advantages over dialysis:

• Eliminates the need for life-long, daily dialysis treatments
• Fewer diet restrictions
• Improved appetite and growth
• Less rigid daily schedule when dialysis no longer needed

Potential Risks and Complications

Transplant candidates and their families must also consider the potential for surgical complications and other risks that accompany transplant surgery. Potential risks and complications include the following situations:

• In some cases the transplanted kidney will fail to work or be rejected by the recipient's body at any time. Then the recipient would need to have dialysis and wait for another kidney transplant.
  
  
• Anti-rejection medications need to be taken for as long as the transplanted kidney functions. These medications have many possible side effects, and the long-term expense of these medications is an important factor for families to consider.
  
  
• In some patients the original kidney disease can return after transplant. Transplant candidates must discuss their individual risk for recurrence with a nephrologist.
  
  
• If a living donor is not available, there is often a long waiting period for a cadaver kidney.