Kidney Transplant

A kidney transplant may be performed if your child loses most kidney function. Healthy kidneys perform the vital function of cleaning the blood by removing excess fluid, minerals and waste. They also make substances that help keep the bones strong and blood healthy. When the kidneys fail, harmful substances can build up in the blood, negatively affecting the whole body.

During a kidney transplant, your child will receive one viable kidney from a matched donor. Only one donated kidney is needed to replace the function of both kidneys. After the transplant, your child must take prescribed medicines twice daily to prevent transplant rejection and minimize side effects such as infection, high blood pressure and cholesterol problems.

Kidney transplants can treat end stage kidney disease secondary to many kidney conditions, including:

Congenital anomalies of the kidneys and the urinary tracts such as dysplasia, obstructive uropathy or reflux nephropathy
Focal segmental glomerulosclerosis (FSGS)
Chronic glomerulonephritis
Polycystic kidney diseases (a congenital kidney disease)
Hemolytic uremic syndrome (HUS)

A successful kidney transplant requires a coordinated effort from your child’s entire healthcare team. The transplant team with IU Health Transplant at Riley Children's Health includes a pediatric nephrologist, transplant surgeon, transplant coordinator, pharmacist, dietitian, social worker and sometimes a pediatric urologist, psychologist and psychiatrist.

Before considering kidney transplant as a treatment, our kidney transplant team will work with you to determine if a transplant is a good choice for your child. While there is no minimum age requirement for a kidney transplant, your child must reach the minimum body size to accommodate a donor kidney. If it is decided that transplant is the best treatment option, the next step is to find a matching kidney. Family and friends are first tested as a potential match. If no match is found, then your child will be placed on the transplant waiting list. Please note that IU Health Transplant at Riley Children's Health only uses adult donor kidneys.

A kidney match is determined by:

• Blood type. The blood type of a donor and recipient must be compatible.
• Human leukocyte antigen (HLA) factors. These are genetic markers on your white blood cells. A higher number of matching antigens between a donor and recipient increases the odds that the kidney will last for a long time.

If a potential matching kidney is found, a series of blood tests will be performed. They include:

Tissue typing and panel of reactive antigens (PRA). Your child’s doctor will run this blood test monthly, including right before the transplant, to ensure that the donor’s body tissue is compatible with your child’s body tissue.
Serum crossmatch. Your child’s doctor will run this blood test several times, including immediately before the transplant. This test takes about four to five hours to complete. This test ensures that the antibodies in your child’s body will not negatively react to the donor kidney, which would result in your child’s body immediately destroying the donor kidney. The transplant team may use the term "negative cross match" to describe the desired result of this test, which means that your child’s antibodies do not react to the donor.

What to Expect

You can expect the following prior to your child’s kidney transplant operation at Riley at IU Health:

For living donor transplants, the donor and your child will come into the hospital for a preoperative work-up two days prior to the surgery. Then, you and your child will return to the hospital the morning of the surgery.
If your child is receiving a kidney from a deceased donor, he or she will generally be admitted the day before the transplant. The pediatric nephrologist will evaluate your child and decide whether he or she needs to receive dialysis prior to the transplant. Most children who are on peritoneal dialysis will dialyze the night before the transplant and will have the fluid emptied completely by 6 am on the morning of the surgery.
Your child will generally need to fast (avoid eating and drinking) for at least eight hours prior to the surgery.
When you arrive at the hospital, your child’s surgeon will explain the procedure to you and your family and answer any remaining questions you may have. You will be asked to sign a consent form for your child’s surgery, which you should read carefully. Make sure you ask any questions you may have about the consent form.
You and your child will be escorted to a private room where he or she will change into a hospital gown. The surgery team will then come to prepare your child for surgery.
An IV line may be inserted in your child’s arm or hand.
Your child may receive a sedative prior to the transplant surgery to help him or her relax.
When it is time for the surgery, an anesthesiologist will transport your child to the operating room.

During the surgery:

A catheter will be inserted into your child’s bladder. Your child will then be positioned on his or her back on the operating table.
The doctor will insert a tube through your child’s mouth into the lungs. This tube is attached to a ventilator, which will help your child breathe during the transplant surgery.
The anesthesiologist will continuously monitor your child’s heart rate, blood pressure, breathing and blood oxygen level during the surgery.
After your child is under anesthesia, the anesthesiologist will place an IV in your child’s neck and wrist to monitor his or her blood pressure and other vital signs.
The skin over the surgical site will be sanitized with an antiseptic solution, and the doctor will make an incision (usually 8-10 inches) into the lower abdomen on one side.
For a child who is receiving a deceased donor kidney, the surgeon will visually inspect the kidney prior to making an incision.
After exposing the blood vessels, the surgeon will place the kidney into the abdomen and connect the blood vessels and ureter to the bladder.
Prior to finishing the bladder connection, a stent (plastic tube) will be placed into the kidney and then down into the bladder to keep this connection open while it heals. This stent will usually be taken out in six weeks by a pediatric urologist.
The incision in the abdomen will be closed with stitches. Surgical glue will be used as a dressing.

You can expect the following immediately after surgery:

Your child will be taken to the pediatric intensive care unit (PICU) after the surgery. Doctors and nurses will closely monitor his or her blood pressure, pulse and breathing. You should expect for your child to stay in the PICU for two to three days before being moved to a regular hospital floor for the remainder of the hospital stay (the average is seven to 14 days).
Your child's care team will carefully monitor urine output to ensure the new kidney is performing correctly. The catheter will remain in the bladder for three to four days before being removed, so your child can urinate normally.
Your child will receive immunosuppression (anti-rejection) medicines to prevent transplant rejection. His or her condition will be closely monitored to ensure he or she is receiving the optimum dose and the best combination of medicines. Your child will also be given pain medicine.
Your child will receive IV fluids until he or she can eat and drink enough by mouth. Your child will only drink liquids at first and will begin eating more solid foods as can be tolerated.
Your child's care team will draw blood frequently to monitor the new kidney as well as ensure that the liver, lungs and blood system are functioning properly.
If your child's condition allows, he or she will be encouraged to get out of bed and move around several times a day beginning the day after the surgery.

Returning Home

The care team will provide specific instructions when your child is discharged from the hospital. Below are some guidelines for when you return home:

Your child will take immunosuppressant medicines on a twice-a-day basis indefinitely after his or her transplant surgery. Some of the common immunosuppressants include tacrolimus and mycophenolate. These medicines keep the immune system from attacking the donor kidney, which would cause a transplant rejection. Because immunosuppressant medicines weaken the immune system, your child will be more susceptible to infections and malignancies. Other side effects of immunosuppressants include diarrhea, high blood pressure and diabetes.
Children with kidney disease often eat a very restricted diet in order to avoid the buildup of certain minerals in the blood that are not being properly filtered by the kidneys. Your child's diet will be, in general, far less restrictive after a kidney transplant. He or she will be able to drink more fluids and eat many of the high-potassium fruits and vegetables that were once off limits, such as bananas, avocados, oranges, spinach, kale, potatoes and tomatoes. Following the transplant, your child may also be encouraged to eat foods high in phosphorous, a mineral that is often advised to be avoided for those with kidney conditions. A dietitian will provide education on healthy food choices that will help your child gain weight and grow stronger after transplant surgery.
Taking immunosuppressants and following the post-transplant diet decreases the chances of a transplant rejection, but there is always a chance that your child's body will reject the donated kidney. Signs of rejection to watch out for include fever, soreness in the area where the kidney was placed and your child urinating more or less frequently than normal. If you notice any of these symptoms, contact the transplant team immediately. However, most rejection episodes are asymptomatic. Therefore, it is imperative for your child to get bloodwork as often as prescribed, as abnormal blood test results might be the only indication that rejection is taking place.

The outcomes for patients who have received a kidney transplant are generally very good, especially when patients follow the guidelines above.

Research on Kidney Transplant

IU Health Transplant at Riley Children's Health is a member of the Improving Renal Outcomes Collaborative (IROC) network, which is part of the Collaborative Chronic Care Network (C3N). IROC brings together families, clinicians and researchers from several prestigious children’s hospitals in order to inspire new research in the field of kidney transplant and improve outcomes for children with kidney transplants. An internal grant from the Department of Pediatrics at the Indiana University School of Medicine made this membership possible.

Support Services & Resources

We offer a broad range of supportive services to make life better for families who choose us for their children's care.

Learn More About Riley Support Services

National Kidney Foundation

This organization provides information and support for patients who are undergoing a kidney transplant.

Locations

In addition to our primary hospital location at the Academic Health Center in Indianapolis, IN, we have convenient locations to better serve our communities throughout the state.