Pediatric Kidney Transplant - Child Kidney Transplant
Pediatric kidney transplant replaces a child's failed kidneys with a healthy kidney from a living parent or relative, restoring growth, energy and school life in a way dialysis cannot. Transplant before dialysis gives the best survival. Our pediatric nephrology and transplant team evaluates child and donor, prepares the bladder where needed, performs both operations and follows you once you are back home.
About This Department
For a child with kidney failure, a transplant works better than dialysis. Ideally it comes before dialysis starts at all.
Pediatric kidney transplant, or child kidney transplant, replaces a child's failed kidneys with one healthy kidney, for most children from a living parent or relative. The commonest reasons are kidneys and urinary tracts that formed abnormally before birth, followed by nephrotic syndrome, inherited diseases such as cystinosis and polycystic kidney disease, and kidney damage after infections. Transplant restores growth, energy and schooling in a way dialysis cannot. In an Australian and New Zealand registry of 1,634 children followed for four decades, the risk of death on dialysis was more than four times that after transplant (McDonald and Craig, New England Journal of Medicine, 2004). A transplant done before dialysis becomes necessary, called preemptive, gives the best results of all. This page explains the causes, transplant against dialysis, timing and size, the living donor, evaluation of the child including the bladder, the operation, life after transplant, complications, and how families from abroad arrange treatment at Biruni Hospital in Istanbul.
Why children need a kidney transplant
| Cause | What it is | Transplant note |
|---|---|---|
| Congenital anomalies of the kidney and urinary tract, CAKUT | Small or malformed kidneys, blocked or refluxing urinary tract, posterior urethral valves | The bladder must work before transplant |
| Nephrotic syndrome, FSGS | Kidney filters damaged, heavy protein loss | Can recur in the new kidney |
| Inherited diseases | Cystinosis, polycystic kidneys, nephronophthisis, Alport syndrome | Some need treatment of other organs too |
| Hemolytic uremic syndrome | Kidney damage after infection or a complement defect | Atypical forms need special medicine |
| Glomerulonephritis | Immune inflammation of the kidneys | Transplant after the disease settles |
Congenital anomalies of the kidney and urinary tract cause about half of kidney failure in children.
Transplant or dialysis
Treatment with dialysis was associated with a risk of death more than four times as high as renal transplantation, and increasing the proportion of children treated with transplantation rather than dialysis can improve survival further (McDonald and Craig, 2004).
| Aspect | Dialysis | Transplant |
|---|---|---|
| Survival | Lower | Higher |
| Growth and development | Slowed | Improves, especially in younger children |
| School and daily life | Sessions or nightly treatment | Normal attendance after recovery |
| Diet and fluids | Strict limits | Few limits |
Transplant before dialysis
Compared with children undergoing preemptive transplantation, children on dialysis for more than 18 months had an 89 percent higher risk of death, regardless of donor source (Amaral and colleagues, Kidney International, 2016).
Choosing the right moment
Too early wastes kidney function, and too late costs health.
The team tracks the child's kidney function, growth, blood pressure, anemia and bone health over months, and plans transplant for the point where the remaining kidneys can no longer keep up, ideally before dialysis. That point differs from child to child. Numbers alone do not decide. A child growing well at school with 15 percent function may wait a little, while another with the same number who has stopped growing, feels tired all the time and cannot keep food down is ready now. Donor testing starts months ahead, because it takes time.
Families decide nothing alone. The team walks them through each step.
Age and size
| Child | Where the kidney is placed | Special points |
|---|---|---|
| Under about 10 to 15 kilograms | Inside the abdomen, joined to the aorta and vena cava | Many centers wait until the child reaches this weight, with dialysis if needed |
| Older children | Lower abdomen, outside the peritoneum, as in adults | Standard technique |
| Adolescents | As in adults | Attention to taking medicines independently |
The living donor
| Criterion | Usual requirement | Note |
|---|---|---|
| Age | 18 to about 65 | Assessed individually |
| Blood group and crossmatch | Compatible, negative crossmatch | Incompatible transplants possible in selected cases |
| Health | Normal kidney function, no diabetes, normal blood pressure | Two healthy kidneys needed |
| Relationship | Family member, with documents | Required by Turkish law for foreign patients |
Is it safe for a parent to give a kidney?
| Time | Stage | Activities |
|---|---|---|
| Days 1 to 4 | Hospital | Walking from the first day |
| Weeks 2 to 4 | Home recovery | Light activity, no heavy lifting |
| Weeks 4 to 6 | Back to normal | Work and most sport |
Surgical mortality from live kidney donation was 3.1 per 10,000 donors, and long-term risk of death was no higher for live donors than for matched healthy nondonors (Segev and colleagues, JAMA, 2010).
Evaluation of the child
| Test | Purpose | Note |
|---|---|---|
| Blood group, tissue typing, antibodies | Match with the donor | Crossmatch repeated just before surgery |
| Bladder assessment, urodynamics | Checks the bladder can hold and empty urine | Essential in urinary tract anomalies |
| Heart and blood vessel scans | Fitness and vessel access | Planned for small children |
| Infection screening, CMV and EBV | Guides medicines after transplant | Vaccinations completed beforehand |
The operation
| Period | Where | Main focus |
|---|---|---|
| Days 1 to 3 | Pediatric intensive care or transplant unit | Fluids, urine output, blood flow in the kidney |
| Days 4 to 10 | Transplant ward | Medicine levels, catheter and drain removal |
| Weeks 2 to 6 | Nearby accommodation | Clinic visits two to three times a week |
After transplant
Immunosuppressant medicines are taken every day for as long as the kidney works. Missing doses is the commonest preventable cause of losing a transplanted kidney, especially in teenagers.
Adolescence is the riskiest period for a transplanted kidney. Teenagers take over their own medicines gradually, with support.
| Item | Frequency | Purpose |
|---|---|---|
| Blood and urine tests | Weekly at first, then monthly, then every three months | Kidney function, drug levels |
| Ultrasound | As needed | Blood flow and drainage |
| Growth and development | Every visit | Height, weight, school progress |
Growing up with a new kidney
Growth picks up after transplant.
Younger children gain the most, and some catch up in height, while teenagers gain less because their growth plates close sooner, which is one reason to transplant early. Appetite improves and diet opens up. Children return to school within two to three months and can play most sports, avoiding hard contact over the kidney. Schools are told about infection risks and the need for medicines at set times. The move to an adult transplant clinic happens in the late teens, prepared over several years so that the young person arrives able to manage their own care.
Complications
| Complication | When | Treatment |
|---|---|---|
| Acute rejection | First months, sometimes later | Steroid pulses or other treatment, usually reversed |
| Recurrence of FSGS | Days to weeks | Plasma exchange and other treatment |
| Infections, CMV, EBV, BK virus, urinary infections | First year mostly | Antivirals, adjusted immunosuppression, antibiotics |
| Post-transplant lymphoproliferative disorder | Months to years | Reduced immunosuppression, rituximab |
| Chronic rejection | Years | Slows kidney loss, second transplant in time |
Parents learn the warning signs before discharge and have a number to call day and night.
| Sign | Possible cause | What to do |
|---|---|---|
| Fever | Infection or rejection | Call the team the same day |
| Less urine, swelling, rising blood pressure | Rejection or blockage | Call the team |
| Vomiting and unable to keep medicines down | Risk of low drug levels | Call the team at once |
Good adherence, blood pressure control and prompt treatment of infections are what keep a transplanted kidney working longest.
For families from abroad
One coordinator from the international patients office handles arrangements from the first message through discharge and answers the same WhatsApp number once you are back home. The office works in English, Arabic, French, Russian, Serbian, Romanian and Spanish and books interpreters for other languages, and it arranges the visa invitation letter, airport transfers, daily transport and accommodation near the hospital. Halal, vegetarian and diabetic meals, a prayer room on site, and a female physician on request wherever the rota allows.
| Document | Purpose | Note |
|---|---|---|
| Family register or birth certificates | Proves the relationship | Apostilled or consular-certified, translated |
| Passports of child and donor | Identity | Valid for the whole stay |
| Medical reports | Diagnosis, dialysis history, blood group | Sent before travel |
Cost
The quote is a package covering child and donor, based on the child's condition.
| Item | Included | Priced separately |
|---|---|---|
| Evaluation | Child and donor tests, consultations | Bladder surgery or other preparation |
| Surgery | Both operations, intensive care, hospital stay | Treatment of complications, stent removal if done later at home |
| After discharge | Clinic visits and tests during the stay | Medicines after return home, accommodation |
References
- McDonald SP, Craig JC. Long-term survival of children with end-stage renal disease. N Engl J Med. 2004;350(26):2654-2662.
- Amaral S, Sayed BA, Kutner N, Patzer RE. Preemptive kidney transplantation is associated with survival benefits among pediatric patients with end-stage renal disease. Kidney Int. 2016;90(5):1100-1108.
- Dharnidharka VR, Fiorina P, Harmon WE. Kidney transplantation in children. N Engl J Med. 2014;371(6):549-558.
- Segev DL, Muzaale AD, Caffo BS, et al. Perioperative mortality and long-term survival following live kidney donation. JAMA. 2010;303(10):959-966.
Editor's note
Written by the Biruni Hospital medical editorial team. Reviewed by Specialist Surgeon Dr. Gürkan Gürsoy, Gynecology and Obstetrics.
Medically reviewed by
Specialist Surgeon Dr. Gürkan Gürsoy
Gynecology and Obstetrics
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