Pediatric kidney transplantation is indicated for patients with chronic kidney failure, a condition in which the kidneys have lost their normal ability to function, including removing toxins from the blood and properly regulating the body’s fluid balance. At IRCCS ISMETT, a multidisciplinary team of pediatricians, surgeons, and anesthesiologists supports children throughout every stage of the transplant process.
Over the past 20 years, IRCCS ISMETT has developed extensive experience in kidney transplantation, performing more than 1,000 kidney transplants, 40% of which were from living donors. The first pediatric kidney transplant was performed in 2000. In half of the pediatric cases, the kidney was donated by a living donor. Over 16 years of experience, the overall survival rate among pediatric recipients has been 94%, one of the best outcomes in Europe, particularly considering the high complexity of the cases treated, including combined liver-kidney transplants.
Pediatric kidney transplantation may be performed using a kidney from either a deceased or living donor. The new kidney is placed in the recipient’s lower abdomen, near the pelvis, an ideal location for connecting it to the blood vessels, namely the artery and vein, and to the bladder. In younger children, the kidney may be positioned higher in the peritoneal cavity for technical reasons. The recipient’s own kidneys are generally left in place and removed only when clinically necessary. If there are no structural or functional abnormalities of the bladder or urethra, the ureter is connected directly to the bladder, allowing the patient to urinate naturally after surgery.
Among children between 6 and 10 years of age who undergo kidney transplantation, the five-year patient survival rate is approximately 98%.
Over the past 15 years, significant improvements have been achieved in short- and medium-term outcomes, including fewer rejection episodes and fewer adverse effects. Most children return to a normal life within the first few months after transplantation.
Living donor pediatric kidney transplant
A pediatric living donor kidney transplant program is active at ISMETT. The program significantly reduces waiting times on dialysis, allowing this step to be skipped on many occasions. Avoiding dialysis can be a big advantage, especially in children, when the body is growing. This is referred to as a preemptive kidney transplant, performed before dialysis is started and when the child is in stage 4 chronic kidney failure.
One of the main benefits of a living donor kidney transplant is that it minimizes ischemic damage related to kidney procurement. In fact, a living donor transplant is a planned procedure and the time between procurement of the donor’s kidney and its placement in the recipient is minimal. In case of a pediatric living donor kidney transplant, it is usually one of the parents who donates, or a parent who is of age. The conditions of the donor candidate shall always be studied in detail to ascertain the good clinical conditions and the absence of any contraindication, without impairing renal function.
The donor is assessed by a multidisciplinary medical-surgical team to ensure the candidate is as secure as possible. A psychological evaluation is planned, consisting of sessions and interviews. At IRCCS ISMETT, the kidney procurement from a living donor is performed with mini-invasive and laparoscopic techniques and allows the best and fastest recovery of the patient after the procedure.
IRCCS ISMETT has gained considerable experience over the last 20 years performing over 400 kidney transplants, 50% of which from living donors.
