Pediatric living kidney transplantation
Overview
Renal transplantation is the best treatment for children with end stage renal disease. A kidney transplanted from a living donor offers distinct advantages compared to that of a deceased donor. There is a shorter wait time for the recipient, a faster recovery and there is growing evidence that living donor kidneys last longer. Living donor kidney transplantation is a complex operation which needs carefully pre-operative evaluations of donors and recipients. Furthermore, pediatric living renal transplantation need delicate donor and recipient operations and intensive postoperative care of the recipient for closely hemodynamic monitoring and fluid and electrolyte management. A successfully transplanted kidney allow children live longer, feel better, and start to eat a normal, healthy diet so they can grow and develop.
Features Summary
Recipient: children ≥ 2 years with body weight ≥10kg
Indications :End-stage renal disease caused by
・Obstructive uropathy
・Lupus nephritis
・Polycystic kidneys
・Dysplastic kidneys
・Hypertensive disease
・Focal segmental glomerulosclerosis (FSGS)
・Alport syndrome
・Hemolytic uremic syndrome
・Cystinosis
・Oxalosis
・Drug toxicity (chemotherapy, transplant nephropathy, drug overdose)
Our Multidisciplinary Team
- Program Director： Chang, Jei-Wen, Pediatric nephrologists
- Surgical Chief： Dr. Tsai, Hsin-Lin, Pediatric transplant surgeon
- Pediatric critical care unit and physicians
- Pharmacists
- Dietitians
Procedure
STEP. 1 Making An Appointment
You may refer to Taipei Veterans General Hospital registration service.
E-mail: imsc@vghtpe.gov.tw
Office Hours: Monday to Friday 08:00-12:00;13:30-17:30.
STEP.2 Application review
The requirements of being a living kidney donor:
(1) The donor has to be at least 20 years old, healthy, and related by blood within 5 generations to the recipient,
or to be the spouse of the recipient. According to the law, the donor needs to be in the marriage with the
recipient for at least 2 years, having children with the recipient, or married to the recipient a year before the
recipient is diagnosed having the need of kidney transplant.
(2) Both kidneys function normally.
(3) The donor does not have the following diseases: diabetes, high blood pressure and tuberculosis. The donor
does not have history of malignant tumors or infectious diseases which are forbidden by law such as AIDS.
(4) The donor donates his/her kidney of his/her own free will and pure
(5)The blood type requirements of the donors：
The same or compatible blood types of the donor and the recipient is the first
STEP.3 Special Outpatient Service
Schedule an appointment, including consultations and follow-up care.
Depending on the treatments, we will estimate the medical cost. You will need to pay the deposit before staying in the hospital. The patient will only pay for the service and treatments they use (the hospital will return the rest of the money).
STEP.5 Clinic/ inpatient arrangement
- The evaluation of being a living kidney donor
It takes 4-8 weeks to complete the evaluations step by step. If the donor is in good medical, social, psychological and metal health, the surgery will be arranged after our medical ethics committee approves the application.
(1) Blood test：the function of the kidneys and the liver, blood counting, anti-HAV, anti-HBV, anti-HCV, blood type,
syphilis, AIDS, hemostasis and tissue matching
(2)Image check：chest X ray, abdominal ultrasound, breast ultrasound, mammography (female)
(3)Other: electrocardiography, urinalysis and urine cytology
Step. 2
[1] Blood test: Virus antibodies, tumor indexes, thyroid function and tuberculosis
[2] Image check: kidney CT and comprehensive renal function test (ERPF)
Step. 3
[1] Mental status examination
[2] Evaluation of social workers
[3] Blood cross matching : To make ensure feasibility and compatibility for renal transplantation
- The evaluation of being a living kidney recipients
A series of laboratory studies similar to the donors will be arranged. In addition, urodynamic evaluation should be performed in children with a history of voiding dysfunction (eg, incontinence) or major reconstruction of the lower urinary tract.
- Medical ethics committee approval
According to the Human Organ Transplant Regulations of Taiwan, the comprehensive information both of the donor and the recipient need to be reviewed by our medical ethics committee. The surgery will be arranged with its approval.
STEP.6 Treatments
Donor and recipient operations are performed simultaneously in two operation rooms. There are two operative and anesthetic teams.
- Surgery approaches and procedures of the donors
A living kidney donation is performed under general anesthesia. Therefore, during the surgery, you will not feel anything. In order to detecting the central venous and blood pressure, a central venous catheter will be inserted in the right part of your neck, and an artery catheter will be inserted in your upper limb. The use of a foley catheter is also necessary.
There are 2 approaches of the surgery：Traditional open surgery and Minimal Invasive laparoscopic surgery
(1) Traditional open surgery:
It is performed in the abdominal cavity with a 10~15cm laparotomy wound (or
flank incision). First step is separating the kidney artery, kidney vain and proximal
ureter, at the same time, separating the kidney from the surrounding tissues.
Afterwards, the doctor will remove the whole kidney and preserve it in organ
preservation solution. After the kidney is completely removed and the bleeding is
stopped, the doctor will stitch the incision.
(2) The minimal invasive laparoscopic surgery:
It offers smaller incisions, equally successful outcomes, less pain, shorter recovery
time and less days staying in hospital. First, the doctor will make 3 small incisions
(each about 1cm length) and infuse carbon dioxide into the abdominal (or
retroperitoneal) cavity. Through these incisions, the doctor can insert the
instruments and a camera in the donor’s body to perform the surgery. In the end,
the kidney will be removed from the incision of the lower quadrant of the
abdomen.
- Surgery approaches and procedures of the donors
Pediatric kidney transplant surgery usually takes 4 to 6 hours and is performed under general anesthesia. Transplant surgeons typically make an incision in the lower abdomen, where they connect the new kidney by attaching it to blood vessels and the bladder. The nonworking kidneys are usually left in place. Simultaneous native nephrectomy is only indicated in children with refractory hypertension or excessive protein in the urine and polycystic kidney disease.
Following surgery, a urinary catheter will be inserted to drain the urine from the bladder.
STEP. 7 Nursing Care Plan
- Hospital stay after surgery
Recipient: depends on his or her medical condition and recovery. Most are around 2-4 weeks
Donor: They usually need to stay in hospital for 5-7 days or longer depending on their recovery.
STEP. 8 Applying for medical records/certificate of diseases
The applies for certificates of diagnosis while staying in hospital will need to prepare the draft made by your doctor. Then, bring it to division of medical affairs admission (the inpatient counter on 1st floor in the Zhongzheng building) for an official copy.
STEP. 9 Revisits/follow-ups
After discharged from hospital, you need to visit your doctor to follow up your condition once a week in the beginning. In the long term, you are advised to take blood tests to measure the kidney functions, test for urinary protein every year.
Notification
Risks and complications of living donors
The remaining kidney of a healthy donor, who received a full evaluation before the surgery, performs its normal function. According to long term follow-up studies, the life expectancy or the incidence of chronic kidney diseases (uremia) of the donors is the same with people who have not had the surgeries.
The incidence of complications is 8%-16%, including
- Infection (2.4%)
- Pneumothorax (1.5%)
- Major bleeding and in need of bleeding control (<1%)
- Pulmonary embolism (1%)
- Ureter stricture and urinary incontinence (2-10%)
In the long-term, there may be 30% decrease of the glomerulus filtration rate of the kidney, with mild proteinuria or high blood pressure; but the overall renal function and incidence of chronic kidney disease does not increase after donation.
Risk and complication of recipients
- Immediately after the operation
- Blooding
- Urine leakage
- Delayed graft function —New kidney may take some time – up to several weeks or occasionally longer – before it starts working, Occasionally, children need dialysis for some time before the kidney is fully functioning.
- Thrombosis (blood clot) – occasionally, if a blood clot is large, it can block the blood flow to the kidney.
- Infections
- Long-term
- Immunosuppressant drugs-related side effects include: Hypertension, cardiovascular disease, Infection, weight gain
- Recurrent infection
- Malignancy
- Type 2 diabetes
- Rejection: This may happen suddenly (acute rejection) or over a longer time (chronic rejection).
-
Graft loss –the new kidney does not work for one of the above reasons or another reason.
★★★Special medical achievements and media coverage★★★
Successfully completing the lowest weight kidney donation in Taiwan and setting a new record by transplanting two kidneys into two pediatric patients
derived from https://www.taipeitimes.com
Estimated Cost
For estimated medical costs, please contact International Medical Services Center.