When a child has end-stage kidney disease, called kidney failure, a transplant may be the most effective treatment. Most kidney transplants in children are successful, and kids can go on to enjoy normal, healthy lives. 

At Yale Medicine, our experts are highly skilled and sensitive to the unique needs of children and their families during this difficult time. Our highly skilled pediatric surgeons, nephrologists, transplant coordinators, pharmacists, social workers, and nutritionists all work together as a team. Additionally, we have the added benefit of communicating with our adult transplant program to ensure our transplant patients continue to thrive through adulthood. 

“Kidney transplant is the is ideal treatment for a child with kidney failure, as it helps restore normal body physiology and allows children to grow and develop more normally,” says Yale Medicine pediatric nephrologist Jillian Warejko, MD. “At Yale, we have a long history of successful pediatric kidney transplants, with 100% graft and patient survival at 1-year post-surgery.”

The most common causes of pediatric kidney failure, or end-stage kidney disease, are birth defects and genetic conditions. Less commonly, older children and teenagers may develop kidney disease as a result of an infection, a physical trauma, or diseases involving other organs, such as lupus, diabetes, and other autoimmune conditions.

Most pediatric kidney transplant recipients are teenagers, but the surgery can be done on children as young as a year old and as small as 22 pounds. Babies who are below those benchmarks may be considered for transplants case by case, or they may receive kidney dialysis until they grow a bit more. Yale can provide both dialysis and transplant services for pediatric kidney failure patients. 

Congenital abnormalities of the kidneys are sometimes discovered in utero, so doctors can know even before a baby is born that he or she may need a kidney transplant.  We work closely with the Yale Fetal Care Center to help prepare these families. 

Other times, those issues are not detected early, and children begin to develop symptoms of kidney disease over months or years. These symptoms can include:

• Fatigue
• Short stature
• Not developing as expected for a child’s age
• High blood pressure

Once doctors know that a transplant is needed and the child is healthy enough to receive a transplanted kidney, they try to find a new kidney as soon as possible. The child and their parents will meet members of the transplant team who will make sure they understand the procedure and recovery process. Transplant evaluation involves meeting with all members of the transplant team, including our social worker, pharmacist, nutritionist, and infectious disease doctor, plus any other specialist your child may have, to ensure the best outcome possible. 

Pediatric transplant coordinators will also speak with the child’s family about the possibility of a living donor. Any adult family member, friend, or an altruistic donor may be able to donate a kidney, which can reduce the time to kidney transplant. 

Matches are made based on blood and tissue typing, and the process is organized by the transplant coordinators. The child can also be put on a waiting list for a kidney from a deceased organ donor. Children under 18 years old are given priority on the deceased donor list.

If a living donor is cleared by the donor advocate team, then a date is discussed with the donor and family, and the surgery is scheduled. While waiting for the surgery, the child continues to receive offers from the donor pool with pediatric priority if the family desires.

Even when a family does receive a call, the kidney still is not guaranteed. A last-minute blood test, called cross-matching, is performed to ensure that the patient’s body will not reject the new organ.

Kidney transplant surgery lasts 3 to 4 hours and is performed under general anesthesia. Transplant surgeons typically make an incision in the lower abdomen, where they connect the new kidney by attaching it to blood vessels and the bladder. The nonworking kidneys are usually left in place, unless they are causing problems such as high blood pressure or excessive protein in the urine.

The incision typically heals quickly, and the new kidney begins working within a few hours. In the case of a living donation, the kidney works usually before the patient is out of the operating room. In some cases, a drain may be used for a few days to collect fluid and watch for leaks. The transplant team will prescribe medications to help manage pain after surgery, to prevent infection, and to prevent rejection of the new kidneys. Most patients go home from the hospital within a week and can resume a normal diet within a few days.

Kidney transplant recipients need frequent checkups in the first year post-transplant—this eventually decreases to checkups every 3 months after a year post-surgery, if there are no complications. Lab tests performed at these visits can show whether the transplanted kidney is still working the way it should.

The transplant team also uses these checkups to educate patients about the importance of taking their medications. People who receive a kidney transplant have to take medications every day to keep their bodies from rejecting the organ. Parents should make sure their children stay on top of this important part of their care. Even a few missed doses could put a patient at risk for organ rejection.

For a living donor, the procedure is a minimally invasive surgery, and most living donors are ready for discharge a few days later.

Yale’s pediatric team partners with the adult kidney transplant program, one of the largest in the Northeast. 

Children with congenital defects that affect multiple organs also have access to Yale Medicine’s combined kidney and liver transplant program. Transplant patients also have access to all of Yale New Haven Children’s Hospital’s subspecialists, so every post-transplant need can be met in a timely fashion. 

“The benefit of pediatric kidney transplant at Yale New Haven Children’s Hospital is that our patients have access to all the pediatric sub-specialists they could need, and when it is time for them to move on to adult doctors, we directly coordinate care with the new doctor,” says Dr. Warejko. “This ensures all care is delivered efficiently and with the best quality.”