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When a deceased donor kidney becomes available, timing is critical. The child will need to be ready for the operating room within hours of arrival at Boston Children’s Hospital. For a living donor, the surgery will be scheduled and coordinated with the donor’s surgery at Brigham and Women’s Hospital, which is connected to Boston Children’s via a bridge.
Upon arrival at the hospital, the child goes directly to the Solid Organ Transplant Floor. There, members of the transplant team will perform a physical exam and run blood tests to make sure the child is ready to go to the operating room. The child may need to undergo dialysis before transplant. The recipient’s operation time is planned to match the team’s arrival back at Boston Children’s.
With a deceased donor transplant, it’s possible that when the surgical team sees the donor kidney, it becomes evident the organ is not ideal. Because we only intend to transplant an optimal kidney, the recipient’s surgical procedure is not confirmed until the team is at the donor hospital. The child’s surgery may be cancelled even after receiving medication and having blood tests. If that happens, the child may return home to wait for another potential kidney transplant.
Most kidney transplant surgeries take approximately four to six hours, although this varies depending on the child’s case. During the surgery, a member of the transplant team keeps the family informed about the progress of the transplant.
After the surgery, the transplant recipient will return from the operating room on a cardiac monitor and may also have a breathing machine (ventilator) with a breathing tube in the nose or mouth. In addition, he or she will have several IVs, an abdominal tube and an abdominal dressing. Typically, our older patients go back to the Solid Organ Transplant Floor. Our younger patients, and some of our more complex patients, will go to a single room in the Medical Surgical Intensive Care Unit (MSICU) for monitoring.
Post-transplant, kidney transplant recipients need to take medications to prevent rejection of the new kidney. Without these medications, the immune system doesn’t recognize that this new kidney is helpful and only sees it as foreign. The immune system therefore attacks the kidney, causing rejection. It is important that patients always take their medications as the kidney transplant team recommends, to prevent this from happening.
It’s not always easy to identify a rejection episode, and many children have rejection without any symptoms at all. The transplant team will watch for signs and show the family what to look for. Some of the most common signs include:
If a child has a rejection episode, the anti-rejection medication is increased or a different combination of anti-rejection medications is prescribed. In over 95 percent of these cases, adjusting medications will stop rejection.
Anti-rejection medications work by suppressing the immune system, but that means transplant recipients may be at higher risk for infections. Our team continually monitors the child’s health through blood tests and other exams. The child’s transplant pharmacist works closely with the rest of the transplant team to determine the best medications for the child.
Some of the infections a child may be especially susceptible to include:
This risk of infections is especially high during the first year after the transplant. This is because patients need higher doses of anti-rejection medicines during this time, so their immune systems are especially suppressed.
Sometimes, a new kidney does not function properly for a few days — or even a few weeks. Patients may need a period of dialysis until the kidney “wakes up” and starts working. In very rare situations, patients may need another transplant
Depending on the transplant recipient’s age and size, the average hospital stay is about seven to 14 days. During recovery, the child is monitored closely for rejection, infection and other problems. Medications are adjusted frequently, while monitoring how well the kidney is working. The kidney transplant team, including child-life specialists, therapists and social workers, are available to provide support.
Families are encouraged to take an active role in their child’s care while in the hospital. The partnership with the Pediatric Transplant Center is critical, because the child’s new kidney will need lots of care, attention and monitoring. Having a new kidney is a lifelong commitment. It’s important that the patient and family feel confident and comfortable with all aspects of care before the child goes home.
The transplant team will determine the appropriate medications and will discuss this plan with you before the transplant, during the admission and during outpatient clinic visits. The medication plan will include anti-rejection medications that will be taken for the rest of the child’s life. With the assistance of the transplant pharmacist, the family will learn to identify medications as well as discuss the usage and side effects of each medication. The pharmacist will meet regularly with the family prior to the child’s discharge.
We are grateful to have been ranked #1 on U.S. News & World Report's list of the best children's hospitals in the nation for the third year in a row, an honor we could not have achieved without the patients and families who inspire us to do our very best for them. Thanks to you, Boston Children's is a place where we can write the greatest children's stories ever told.”