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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.
While the child is being prepared for surgery, a team is leaving to obtain the donor kidney. The recipient’s operation time is planned to match the team’s arrival back at Boston Children’s.
With a deceased donor, it’s possible that when the surgical team sees the donor kidney, it becomes evident the organ is not ideal. Because we only 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 returns home and waits for the next kidney assignment.
Most kidney transplants 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, several abdomen tubes and a large dressing. The child will go to a single room in the Medical Surgical Intensive Care Unit (MSICU) with visiting limitations to protect them from infection during the early post-operative period.
Rejection is a normal and, under most circumstances, healthy reaction of the body’s immune system to a foreign object. When a new kidney is placed in the child's body, his or her immune system attacks it, not recognizing that it is useful. To prevent this, the child will have to take medications to weaken the immune system.
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 few months after the transplant. This is because patients need higher doses of anti-rejection medicines during this time, so their immune systems are especially suppressed.
In vary rare situations, a new kidney does not function properly, or at all, after the operation, and a second transplant operation must be performed immediately.
Depending on the transplant recipient’s age and size, the average hospital stay is 10 to 21 days. A few days are spent in the MSICU and the remaining on the Solid Organ Transplant Floor. When transplant recipients leave the MSICU, they go to a single room on the floor. As the child continues to recover, be monitored for rejection, infection and other problems, medications are adjusted frequently. A child life specialist and a social worker provide additional 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 becomes more important than ever, because the child’s new kidney will need lots of care, attention and monitoring. Having a new kidney is a lifelong commitment. We want each family to feel confident and comfortable with all aspects of care before a child goes home.
The transplant team will determine the appropriate medications. They 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.”