Overview

At Evelina London Children’s Hospital, we have a long history of combining clinical excellence with innovation that continues to place us firmly at the leading edge of paediatric kidney transplants here in the UK and globally.

The first paediatric renal transplant in England took place at Evelina more than 50 years ago, now we undertake approximately 30 transplants per year and have around 100 patients under follow-up post transplant.

Our paediatric transplant unit remains one of the largest in the world, and our specialist paediatric nephrologists are recognised experts in their field, performing pioneering renal surgeries that change the lives of our patients.

What is children’s kidney transplantation?

Just like adults, children can experience problems with their kidneys. However, the causes and type of kidney issues in children are usually very different to those seen in adults.

Common causes of kidney problems in children include:

• congenital abnormalities (abnormalities that occur during a child’s pre-birth development)
• hereditary diseases
• frequent urinary tract infections
• inflammation of the kidneys.

Dialysis is the recommended treatment for children who have conditions such as chronic kidney disease and whose kidney function is severely compromised. However, dialysis is time-consuming, causes unpleasant side effects and can drastically affect the quality of life of a child — such as making it hard for them to go to school.

In some cases, and where the function of a child’s kidneys is severely affected, a consultant may recommend kidney transplantation surgery instead. This is where a donor kidney is surgically implanted to replace the diseased one.

Most paediatric kidney transplant recipients are teenagers, but our expert consultants can perform the surgery on children as young as a year old, and as small as 22 pounds in weight. Your consultant nephrologist will be able to advise if your child is a suitable candidate for kidney transplant surgery.

Procedure details

What happens during kidney transplant surgery?

We understand that the prospect of a transplant can be daunting for both parents and children.

Our aim is to make every step of your child’s treatment as relaxed, calm and compassionate as possible. Knowing what to expect can help ease the anxiety you may have about the procedure.

Kidney donor

As most kidney transplants have a maximum lifetime of around 20 years, children are very likely to need more than one in their lifetime. Generally, the better matched they are with the donor in the first transplant, the easier it will be to match a second transplant donor.

Family members tend to be good candidates, although tests will need to confirm this. And since it’s possible to live with one healthy kidney, living donations are a very popular way to ensure a child receives the kidney that they need.

While a good match is preferable, our expert team do specialise in complex cases. We have the UK’s largest antibody incompatible transplant programme and the only such programme for children.

Before the procedure

You will be told when your child needs to come to hospital for their transplant procedure.

On the day of the transplant, your child will need some blood tests to confirm that they are in good health and the kidney is a good match for them.

As the procedure is performed under general anaesthetic, they will also need to refrain from eating and drinking for a number of hours beforehand. Your transplant team will tell you when this is.

During the procedure

A paediatric kidney transplant is largely the same as an adult procedure.

Firstly, an incision will be made into the lower abdomen through which the donor kidney will be placed. This is because your child’s natural kidney will be left where it is unless it is causing pain or infection.

The blood vessels surrounding the donor kidney will then be attached to it to ensure that it receives the blood it needs to function properly. Finally, the ureter from the donor kidney will be connected to your child’s bladder to complete the circuit so that waste material can flow from the kidney to the bladder to be excreted as urine.

Once the new kidney is in place, the incision will be closed using staples or stitches, and dressed with a bandage. Your child will be taken to recovery where the general anaesthetic will wear off and they will wake up.

In most instances, paediatric kidney transplant surgery takes around three hours, but this can vary between patients.

Recovery

Your child will be closely monitored while the general anaesthetic wears off. They will be given pain medications to keep them as comfortable as possible, and they may be given oxygen for up to 48 hours while their blood oxygen levels return to normal.

As their new kidney could take up to two weeks to start working, they may be given dialysis  until blood tests show that the donor kidney is functioning. They will also be started on medication straight away that will prevent their immune system from attacking their new kidney and trying to reject it.

Your child may need to stay in hospital for up to a week following their surgery, during which time they will be regularly assessed to determine if the new kidney is working. They will also need to attend regular appointments to check their kidney function — as often as three times a week for the first six months. Over time, the frequency of their appointments should be able to be reduced, and after a year, follow-up visits every three to six months is normal.

They will need to refrain from physical activity for up to six weeks while they heal, and should eat a healthy, balanced diet and get plenty of rest while they heal. It’s essential that you help your child to follow the recovery advice outlined to you by their nephrologist.

Life after a kidney transplant

After a successful kidney transplant, most children can go on to live full and active lifestyles that are similar if not the same as their peers. This means attending education, and enjoying sports and other recreational activities. As time goes by, you will probably notice that your child seems to be growing faster, has more energy and generally seems healthier and happier.

To get the very best from their treatment and to preserve their new kidney for as long as possible, your transplant team will want to make sure that you know how to keep your child healthy. They may offer you advice with things like encouraging them to eat a nutritious, balanced diet, getting regular exercise and taking care of their mental health.

The better you and your child look after their new kidney, the longer it should be before further treatment is required.

Our live donor transplant programme

We have one of the largest paediatric transplant units in the world and our living donor transplant programme is one of the largest and most successful in Europe, with a one-year graft survival rate of 99%. Currently, 70% of our transplants are from live donors.

Most people can live with just one healthy kidney. Our live donor transplant programme enables people who wish to donate a healthy kidney to someone who needs a second chance at life — including children.

Our transplant surgeons were the first in the world to use 3D printing to enable the successful transplantation of an adult donor kidney into a child, making it possible for adult blood relatives to donate a kidney to their child (provided that they are a match, of course).

Live donor transplants have a higher success rate than using deceased donors, and the procedure can be done using cutting-edge laparoscopic (keyhole) surgery to improve a patient’s post-operative discomfort and recovery time.

In the past, up to 30% of living donor transplants were considered impossible due to incompatibility. However, our children’s blood group incompatible transplant programme is the largest in the UK — giving children who would have required prolonged dialysis therapy the opportunity to have much faster, successful implants.

Locations

Our patient-centric approach means that our focus is on providing the right facilities to meet the needs of the young people in our care. Evelina London Children’s Hospital was designed around the needs of the children, their families and staff to provide the best possible care.

Our award-winning, state-of-the-art facilities include:

• specialist renal ward for patients needing inpatient treatment
• comprehensive imaging services including MRI, X-rays and ultrasound
• paediatric intensive care unit
• haemodialysis unit
• large home dialysis programme