What is a kidney transplant?
It is an operation in which the diseased kidneys of an individual (the recipient) are replaced with healthy kidneys of another individual (the donor). Usually, the donor's kidney comes from a living donor, usually from a family member or friend. In some cases, the kidney is taken from someone who has recently had a brain death.
Why is a kidney transplant done on a child?
The transplant is reserved for children whose kidneys are so damaged that dialysis is needed, or will be needed, to survive. The transplant offers a long term solution that gives the child the possibility of improving health, greater independence, and more normal life.
How do you make the decision to continue dialysis or to do a transplant?
The decision to refer a child to be considered a transplant candidate is usually taken by the child's nephrologist. Sometimes parents request the evaluation.
The evaluation is a complex and detailed process, which begins with a complete review of the child's medical records by the pediatric renal transplant team. In the course of a full day of appointments, not only are several medical tests done (see How to include my child on the waiting list for a new kidney?), But the child and parents also meet with all the team that includes the surgeon, nephrologist, child life specialist, social worker, transplant coordinator, and family advocate. Along with the medical analysis, the first meeting tells about the social and family needs for transplantation, like protracted living preparations before and after the process for patients residing outside the area.
Where do donor's kidneys come from?
They come from two sources. The first is living donors, of which only one kidney is removed. The best donors are in general family members since they are genetically compatible; normally the father or mother are. Occasionally, someone is found compatible with an unrelated individual. Donors can live normal and healthy lives with the kidney they have left.
The second source is individuals who have recently suffered from brain death. In most cases, a single kidney is transplanted into the recipient, so that each deceased donor provides a kidney to two recipients.
Yes, it is possible. However the pregnancy in the kidney transplant patient remains, despite the progress of obstetrics, a risky pregnancy.
The main risks for the mother are: graft rejection, a kidney disease in pregnant women called vasculo-renal syndrome. The risks for the child are: prematurity, intrauterine growth retardation.
Pregnancy can only be considered after the 2nd year of transplant if a certain number of criteria are met (HAS recommendations) such as: the absence of rejection in the previous year, the proper functioning of the graft, the absence of protein in the urine, normal blood pressure, seriousness in taking anti-rejection drugs, absence of other diseases.
Anti-rejection treatment must be adapted and certain drugs must imperatively be stopped at least 6 weeks before conception.