“After a kidney transplant, what would my child's life be like?”
I have a son who is 7 years old. His kidney condition is slowly deteriorating. After a transplant, what would his life be like?
4 Answers
Essentially Normal except that he will be on immunosuppression
Please visit National Kidney Foundation and UNOS as well as myAST.com
Depends on many factors, but may be very good.
Dear Concerned Parent,
Kidney transplantation is the therapy of choice for end-stage chronic kidney disease (also known as end-stage renal failure). A successful renal transplant offers the best metabolic control, the lowest long-term cardiovascular risk, the best longevity, and a better quality of life despite the need for life-long immunosuppression. It is also the cheapest treatment, even though this should not be a factor.
After transplantation, the child will go from the operating room to the paediatric critical care unit for a couple of days. Physicians may push the fluids to maintain high urine output, which improves the monitoring of the kidney function after transplantation. The team will frequently assess the electrolytes and other factors in the blood to make sure that the transplant will work well. You son will have to take antirejection drugs, which may be highly variable from person to person, and may need a lot of adjustments. There will also be repeated imaging of the transplant. Another potential problem is related to viral illnesses that the donor may have had and your son may not yet have acquired, such as cytomegalovirus and the virus that causes mononucleosis (also known as mono). Prophylaxis against pneumocystis pneumonia infection is also needed, possibly life long. It may be necessary to give prophylactic medications. Rarely the transplant may be slow with picking up function, and the patient may have to continue on dialysis for a while.
Once the patient is more stable, he will return to a regular ward and should be discharged soon thereafter. It is not unusual to have high blood pressure after the transplantation. There may be 3 antirejection medications (typically tacrolimus, mycophenolate mofetil and corticosteroids), infection prophylaxis, blood pressure medications and others. It is not uncommon that a magnesium supplement is needed as tacrolimus can induce magnesium wasting. This usually gets better.
After the discharge home, you will have to come to the hospital frequently to check kidney function and medication levels. Due to a lot of drug interactions especially with tacrolimus, this is of high importance. You may be asked to avoid any grapefruit juice. In some cases, there may also be urinary tract infections. All of this is done to prevent acute rejection of the transplant and to minimize infectious complications.
Over time, the frequency of these visits will drop as the issues diminish. In the long run, it may only be necessary to be seen every 3 months. It will be of the highest importance that the antirejection medications are being taken with absolute adherence to the recommendations as rejection of the transplant still remains a major problem. When your son becomes an adolescent, there will be additional challenges with adherence. It may be very wise to educate him about his new condition as much as possible and to develop habits and routines that help to avoid any non-adherence. Non-adherence may lead to donor-specific antibodies and premature graft loss. Your nephrologist may also treat similar issues as with the chronic kidney disease, for instance the blood pressure, or vitamin D therapy, growth hormone therapy if there is insufficient growth despite of good graft function, etc. . These factors are just as important after the transplant as before.
You may notice a big growth spurt in the first year. You may also notice substantial improvements in the school performance, and in the development. Poor kidney function unfortunately affects school performance and cognitive development. It may take a while before some of the toxins of chronic kidney disease are getting out of the body.
Unfortunately, a transplant is not a cure, and there will be underdosing of nephrons which leads to slow deterioration of graft function. If everything goes well, the transplant may work for 15 or 20 years or longer. Ideally, a second transplant is pursued before the patient needs to go back on dialysis. Antirejection medications, especially tacrolimus, may have to be continued even after graft failure to prevent sensitization, which might make retransplantation very difficult. However, with retransplantation, a very respectable life expectancy can be achieved. Most important is the adherence to the antirejection drugs, which have to be finetuned by your nephrologist to avoid too much of too little of it. Therefore, transplantation is a therapy, not a cure. We are fortunate to have this treatment.
Kidney transplantation is the therapy of choice for end-stage chronic kidney disease (also known as end-stage renal failure). A successful renal transplant offers the best metabolic control, the lowest long-term cardiovascular risk, the best longevity, and a better quality of life despite the need for life-long immunosuppression. It is also the cheapest treatment, even though this should not be a factor.
After transplantation, the child will go from the operating room to the paediatric critical care unit for a couple of days. Physicians may push the fluids to maintain high urine output, which improves the monitoring of the kidney function after transplantation. The team will frequently assess the electrolytes and other factors in the blood to make sure that the transplant will work well. You son will have to take antirejection drugs, which may be highly variable from person to person, and may need a lot of adjustments. There will also be repeated imaging of the transplant. Another potential problem is related to viral illnesses that the donor may have had and your son may not yet have acquired, such as cytomegalovirus and the virus that causes mononucleosis (also known as mono). Prophylaxis against pneumocystis pneumonia infection is also needed, possibly life long. It may be necessary to give prophylactic medications. Rarely the transplant may be slow with picking up function, and the patient may have to continue on dialysis for a while.
Once the patient is more stable, he will return to a regular ward and should be discharged soon thereafter. It is not unusual to have high blood pressure after the transplantation. There may be 3 antirejection medications (typically tacrolimus, mycophenolate mofetil and corticosteroids), infection prophylaxis, blood pressure medications and others. It is not uncommon that a magnesium supplement is needed as tacrolimus can induce magnesium wasting. This usually gets better.
After the discharge home, you will have to come to the hospital frequently to check kidney function and medication levels. Due to a lot of drug interactions especially with tacrolimus, this is of high importance. You may be asked to avoid any grapefruit juice. In some cases, there may also be urinary tract infections. All of this is done to prevent acute rejection of the transplant and to minimize infectious complications.
Over time, the frequency of these visits will drop as the issues diminish. In the long run, it may only be necessary to be seen every 3 months. It will be of the highest importance that the antirejection medications are being taken with absolute adherence to the recommendations as rejection of the transplant still remains a major problem. When your son becomes an adolescent, there will be additional challenges with adherence. It may be very wise to educate him about his new condition as much as possible and to develop habits and routines that help to avoid any non-adherence. Non-adherence may lead to donor-specific antibodies and premature graft loss. Your nephrologist may also treat similar issues as with the chronic kidney disease, for instance the blood pressure, or vitamin D therapy, growth hormone therapy if there is insufficient growth despite of good graft function, etc. . These factors are just as important after the transplant as before.
You may notice a big growth spurt in the first year. You may also notice substantial improvements in the school performance, and in the development. Poor kidney function unfortunately affects school performance and cognitive development. It may take a while before some of the toxins of chronic kidney disease are getting out of the body.
Unfortunately, a transplant is not a cure, and there will be underdosing of nephrons which leads to slow deterioration of graft function. If everything goes well, the transplant may work for 15 or 20 years or longer. Ideally, a second transplant is pursued before the patient needs to go back on dialysis. Antirejection medications, especially tacrolimus, may have to be continued even after graft failure to prevent sensitization, which might make retransplantation very difficult. However, with retransplantation, a very respectable life expectancy can be achieved. Most important is the adherence to the antirejection drugs, which have to be finetuned by your nephrologist to avoid too much of too little of it. Therefore, transplantation is a therapy, not a cure. We are fortunate to have this treatment.
