Kidney Transplant

What Is a Kidney Transplant?

Kidneys are vital organs that filter blood to remove waste, extra fluid, and salt from the body. If they stop working, it's called kidney failure. Someone with kidney failure must go on dialysis or get a kidney transplant.

A kidney transplant is an operation where doctors put a new kidney in the body of someone whose own kidneys no longer work. One healthy kidney will do the work of two failed kidneys.

Because people can survive with just one kidney, a living person can give a healthy kidney to someone with kidney failure. This is called being a donor. A kidney also can come from a donor who has recently died, but the wait for this kind of donated kidney can take a year or more.

Most kidney transplants are successful. People who have kidney transplants will take medicines for the rest of their lives to prevent the body from rejecting the kidney. Rejecting means that the body's immune cells destroy the new kidney because they sense that it's foreign.

But aside from that, many kids and teens who have kidney transplants go on to live normal, healthy lives after they recover from surgery.

What Are the Different Types of Kidney Transplants?

There are two kinds of kidney transplants depending on who donates the new kidney.

A living-donor transplant is when someone gets a kidney from a person who is still alive and well. It's usually from a relative or close friend, but sometimes strangers donate.

A deceased-donor transplant is when people donate their kidneys for transplant after they die. This requires people who need kidneys to put their names on a waiting list until a donor is found.

What Happens Before a Kidney Transplant?

If your child needs a kidney transplant, your first step is to visit a transplant center. The health care team will check to make sure that your child is healthy enough to have surgery and take the medicines needed after the transplant. This will include blood tests, X-rays, and other tests, and can take a few weeks or months.

If the transplant team decides your child is a good candidate, the next step is to find a kidney. In most cases for living donor transplants, a kidney comes from a close relative or friend who has a compatible blood type.

If a living donor isn't found, your child's name will go on a waiting list until a kidney from a deceased donor is matched to your child. The need for new kidneys is far greater than the number donated, so this can take a long time.

You'll stay in close touch with the doctors and the rest of the health care team. Make sure they know how to reach you at all times. When a kidney is located, you'll need to go to the transplant center at a moment's notice.

While you wait for a transplant, keep your child as healthy as possible. That way, they'll be ready for transplant surgery when the time comes. Help your child:

• follow any special diet recommendations/restrictions from the doctor, nurse, or dietitian
• take all medicines as directed
• go to all medical visits

Tell your transplant team right away if there is any change in your child's health, or if you plan to travel more than 2 hours away.

What Happens During a Kidney Transplant?

The doctors will take a blood sample so they can do an antibody cross-match test. They do this to find out if your child's immune system will accept the new kidney. If the test comes back negative, the kidney is acceptable. They'll also do other blood tests, a chest X-ray, and EKG before the transplant. Your child may get intravenous (IV) fluids in preparation for surgery.

In the operating room, your child will get general anesthesia to sleep through the operation. Then the surgeon makes a small cut in the lower belly, just above your child's hips. The new kidney is placed, and the surgeon attaches its blood vessels (artery and vein) to blood vessels in the lower body. Then the new kidney's ureter (a tube that carries pee from the kidney to the bladder) is connected to the bladder.

In most cases, the old kidneys stay in place. They aren't removed unless they cause problems like high blood pressure or frequent infections. Kidney transplant surgery usually takes about 4 to 6 hours. If your child needs more than one organ (such as a combined kidney–liver transplant), the surgery time will be longer.

What Happens After a Kidney Transplant?

After kidney transplant surgery, your child will spend a week or two in the hospital to recover. The health care team will watch closely to make sure there are no problems from the surgery, such as bleeding or infection.

You and your child will learn about the medicines needed to keep the body from rejecting the new kidney. These are called immunosuppressants. Taking them can make your child more likely to get infections, especially in the days right after surgery. So keep your child away from sick people. Everyone at home should wash their hands well and often.

For the first couple of months after surgery, you'll see the doctor often to make sure the new kidney is working well. If your child gets a fever, has diarrhea, has less energy, or has a change in how much they're peeing, contact the transplant office right away. These could be signs that your child's body isn't accepting the new kidney or that they have an infection.

How Can Parents Help?

Having a chronic condition can be hard for kids. Dialysis, surgery, and immunosuppressant therapy can add to the stress. Talk to your child about these changes and how you will work them into your routine. Make sure to find time to do fun things together with family and friends.

For teens, immunosuppressant therapy can be a challenge. These medicines can cause:

• acne or acne that gets worse
• weight gain
• mood swings
• trouble sleeping
• hair loss

Many of these side effects improve over time. But they're a major reason why teens might stop taking their medicines after a transplant. This can be dangerous and even lead to rejection of the new kidney. Do not change or stop any medicines without talking to the care team. In some cases, medicines can be changed to ease the side effects and still be effective and safe. Talk to your child about the importance of taking all medicines as directed, and help them do so.

To help:

• Be there for your child to talk to.
• If your child needs more support, make an appointment with a therapist or counselor.
• Find a support group. They're a great way for kids and teens to relieve stress and connect with others who are going through similar challenges. Online resources include Transplant Living.
• Get support for yourself too. It can help to talk about your feelings with other people who know what you're going through. Ask the transplant care team if they know of support groups for families.
• Discuss any problems with the transplant team.