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Pediatric Kidney Transplant in India | Treatment Possible

Pediatric Kidney Transplant in India

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Know more about pediatric kidney transplantation in India:

The kidneys filter waste from the blood and remove it through your urine. They also help maintain your body’s fluid and electrolyte balance. Kidney failure has a negative impact on a child’s growth, bone strength, and nerves. If your Childs’s kidneys stop working, waste builds up in their body and can make you very sick. This will affect a child’s brain development and function, which causes learning disabilities.

Pediatric kidney transplant is considered the best treatment option for children, who have kidney failure.  A kidney transplant relives your child from having dialysis, which consumes a lot of time and could disrupt your child’s social and school life. If your child is diagnosed with end-stage kidney disease, then talk to their nephrologist (kidney doctor) about the possibility of a kidney transplant. In a kidney transplant, one or both kidneys are replaced with donor kidneys from a live or deceased person. Before planning for a kidne

When will your child require a kidney transplant?

A kidney transplant should be recommended for children who have serious kidney problems and will die without dialysis or a transplant. Some of the kidney diseases in children requiring a transplant include the following:

  • Birth defects and heredity diseases – This is the most common cause of kidney failure in children from birth to age 4.
  • Hereditary diseases, nephrotic syndrome, and systemic diseases –
  • Diseases that affect the blood vessels (glomeruli) in the kidneys – This is the most common cause of kidney failure in children between ages 15 and 19.

It is not a guarantee that all children with the above diseases will need a kidney transplant. Always check with your child’s healthcare provider for a diagnosis.

Who is involved in a kidney transplant team for children?

The transplant team for a child is the same for an adult. However, the members of the transplant team should be specially trained doctors to meet the needs of children with kidney disease:

  • Pediatric nephrologists are doctors who will treat children with kidney disease and kidney failure.
  • Pediatric transplant surgeons are the doctors who will perform kidney transplant surgeries for children.
  • Social workers find resources related to travel to a transplant centre, health insurance, and adjusting to school.
  • Child psychologists or psychiatrists are trained health providers who help children who receive transplants, their siblings, and parents to cope with the emotional changes that happen after the transplant.
  • Dietitians create special meal plans that can keep your child healthy before and after the transplant.
  • Nurses are responsible for patient care, before and after the transplant surgery. They play a major role in the transplant patient’s recovery.
  • Your child’s pediatrician will not be directly part of the transplant team, but you and the transplant team must keep the doctor informed of your child’s health status.

Who will be the kidney donor for your child?

There are two ways that your child can get a donated kidney:

  • Deceased donor: Your child may get a kidney from a healthy person who just died. To get a deceased donor transplant, the name of the child must be added to the national waiting list. The wait for a kidney could take many months or years.
  • Living donor: A healthy, living person may donate one of their kidneys to your child. After donating their kidney, the donor will continue to live a normal, healthy life with one kidney. Almost half of the kidney transplants for children are from living donors.

Donors for children are often their parents, siblings, or other family members. Parents of a child with kidney disease are the best donors because they often have the same blood type and are a tissue match.

What protocol is followed to find a matching kidney donor for your child?

Screening Tests

These below test results will help to match a donor kidney to your child.

  1. Blood Type Testing

    The first test establishes your child’s ABO blood type. There are four blood types namely: A, B, AB and 0, and everyone fits into one of these groups. The recipient and donor must either have the same blood type or compatible ones. The list below shows compatible types. 

    • If your child has blood type A then the donor blood type should be: A or O
    • If your child has blood type B then the donor blood type should be: B or O
    • If your child has blood type AB (universal recipient) then the donor blood type should be: A, B, AB, or O
    • If your child has blood type O (universal donor) then the donor blood type should be: O

    Patients with AB blood type called the universal recipient, are easier to match because they accept all the other blood types. Blood type “O” which is the universal donor is the hardest to match. Although people with blood type “O” can donate to all types, but they can only receive kidneys from blood type “O” donors. For example, if a patient with blood type “O” were given a kidney transplant from an “A” donor, the recipient’s body could recognize the donor kidney as “foreign” and destroy it. 

  2. Human Leukocyte Antigens (HLA)

    The human leukocyte antigens (HLA) is called tissue typing, this is a blood test. These antigens are substances found on many cells of the body but are often seen on white blood cells. Tissue type likeness between family members could be 100, 50 or 0 percent. The tissue type of all potential donors is considered as donor selection.

  3. Crossmatch

    The crossmatch is done by mixing your recipient’s blood with cells from the donor. If your child has antibodies against the donor then the crossmatch will be positive and this kidney should not be received. If the crossmatch is negative, it means your child doesn’t have antibodies to the donor and can receive this kidney.

  4. Serology

    The testing is done for potentially transmissible diseases, such as HIV (human immunodeficiency virus), hepatitis and CMV (cytomegalovirus). 

The matching process:

During your child’s evaluation for a transplant, blood tests will be taken to determine their blood type (A, B, AB, or O) and human leukocyte antigen (HLA). HLA is a group of antigens located on the surface of white blood cells. Antigens are responsible for a body’s immune response.

If the child’s HLA type matches the donor’s HLA type, it’s more likely that the child’s body won’t reject the kidney. Everyone has six antigens, three from each biological parent. The more antigens your child has that match the donor, the greater are the chances of a successful transplant.

Once a potential donor is identified, another test is taken to make sure that the antibodies won’t attack the new organ. This is done by mixing a small amount of the recipient’s blood with the donor’s blood. The transplant cannot be done if recipient’s blood forms antibodies in response to the donor’s blood. 

If the blood shows no antibody reaction, then you have what is called a “negative crossmatch” which means that the transplant can proceed.

Surgery:

Your child’s surgery may last between two to four hours. During the operation, the kidney is placed in the pelvis and not in the usual kidney location in the back. Your child’s kidney will not be disturbed. The artery carrying blood to the kidney and the vein removing blood from it are surgically connected to two blood vessels that already exist in the pelvis. The ureter that carries urine from the kidney to the bladder is transplanted through an incision in the bladder.

After the operation, your child will be taken to the recovery room for a few hours and then return to the Kidney Transplant Unit. The surgeon will inform you after the procedure is over.

Your child will also be encouraged to get out of bed 12 to 24 hours following surgery to walk around the Kidney Transplant Unit as much as he or she can. Nurses will teach your child how to take medications and about side effects and nutrition guidelines after a transplant.

A cadaver kidney will perform as a “sleepy” kidney; this condition is called acute tubular necrosis, or ATN, meaning that the kidney is temporarily slow in functioning. Your child might need dialysis a few times, which will not harm the kidney. The “sleepy” kidney usually starts working within two to four weeks. However, the points mentioned below have to be kept in mind:

  • A child older than 2 years of age could get an adult kidney, as long as the kidney fits in their body.
  • The new kidney is placed in the child’s lower right side of the stomach area.
  • In smaller children, the new kidney is placed in the middle of the child’s stomach area.
  • Usually, the child’s kidneys are not removed.
  • The surgeon uses the donor’s ureter (the tube that the urine passes through) and attaches it to the child’s bladder.

What post-operative care is taken after a kidney transplant?

  • Before your child can be discharged, the transplant team will continue to provide care in the hospital for about a week, though sometimes a longer hospital stay is needed.
  • While in the hospital, your child may have blood tests to check on their new kidney, and given painkillers.
  • The nurse will help your child walk daily (including the day of the surgery), and coach your child through deep breathing exercises needed for healing.
  • Some children may need to go on dialysis briefly after the transplant before their new kidney can start working fully. This does not mean that the kidney is a bad one; it just needs a bit more time to start working. This is more likely to happen if your child gets a kidney from a deceased donor.
  • Before your child is discharged from the hospital, transplant team members will talk to you, your child, and family members about caring for your child, and the importance of properly taking their medicines to keep their new kidney healthy.

What happens after the kidney transplant?

  • Your child needs to limit physical activities until the surgery area is fully healed.
  • Your child must not participate in sports or rough play until the doctor tells you it is safe.
  • You should keep your child’s surgery spot clean and dry to prevent infection.
  • Do not allow your child to be near people who are sick.
  • Pets can carry germs, talk to your child’s doctor if it is safe for them to play with pets.

What medicines are used to keep your child’s new kidney healthy?

There are medicines that your child needs to take every day. The medicines are called immunosuppressants, or also known as anti-rejection medicines. Your child’s immune system protects the body from germs and harmful cells but it may not recognize the cells from the donated kidney immediately, and it would start attacking the new kidney as if it were any disease or germ. To help prevent your child’s kidney from being rejected, immunosuppressant medicines must be taken to slow down the immune system so that it is less likely to reject the new kidney.

What are the symptoms of rejection?

There is a possibility that your child’s body will try to reject the new kidney. If this begins to happen, it is extremely important to call the doctor right away.

If your child shows any of these signs below, you must call the transplant team right away!

  • Fast heartbeat
  • Sudden weight gain
  • Swelling of the child’s body
  • Urinating very little
  • Pain or tenderness at the surgery wound
  • Fever
  • Symptoms similar to the flu – chills, nausea, headaches, body aches and pain

Your child will be given other medicines to help prevent infections and medicines for an upset stomach. You mustn’t give your child any other medicines, including over the counter medicines, without getting permission from the transplant team first.

If you have trouble paying for these important medicines, contact your social worker or the transplant team to refer you to the agencies that can help.

Long-term care for a child after a kidney transplant:

You will probably notice over time that your child will be feeling better, has more energy, is eating better, and is even growing more quickly. Your child’s transplant team can help with some of the life changes:

  • The dietitian can help your child and your family learn about what foods will keep your child’s new kidney healthy.
  • Your child will need to see the kidney doctor (nephrologist) for regular blood tests and medical exams to check how well their new kidney is working.

As your child gets older, you must teach them how to take their required medicines and how to be active in their health care.

Every child is unique and every transplant is different. Results will keep improving as healthcare providers and scientists learn more about how the body deals with transplanted organs and search for ways to improve the transplant process.

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