“Kidney transplantation is a successful permanent solution for chronic kidney failure. In India, on an average, 3000 kidney transplantation surgeries are performed every year”, said Dr. Balasubramaniyam, Chief Nephrologist, Kauvery Hospital, “Majority of the transplantations are performed ehere the donor is living related and a few are from cadaveric donors.”
It is estimated that 1 in every 65,000 children develop End Stage renal disease (ESRD) in children needing dialysis and transplantation. In the US, it is estimated that 1200 children develop ESRD every year. The disease can affect right from the new born period to adolescence.
Addressing the media about the two successful Kidney transplant surgeries performed on a 9 and 11 year old children at Kauvery Hospital, “In these cases, both the children had reached transplant state. The 9 years old boy had congenitally maldeveloped kidneys with high blood pressure requiring multiple blood pressure medications and acid accumulation, making it difficult to control with medications alone. The 11 years old had posterior urethral valve that led to recurrent urinary infection that further led to kidney failure. Both the children have done well post transplantation and had completed one month after surgery.” said Dr. Balasubramaniyam.
Both the kids were managed by Pediatric Nephrologist Dr. Prahalad, till they reached transplant stage. Subsequently Dr. R. Balasubramaniyam, Chief Of Nephrology took over the care. In both these cases, the mother was identified as the renal donor. After proper evaluation of the donor and the recipient, the transplant approval was obtained from the authorization committee. Ms. Hemalatha, transplant co-ordinator guided the process. The anesthetist team headed by Dr. Silamban and the surgical team headed by Dr. V. Muthu and Dr. Jeevagan operated on the donor and the recipient. Transplantation department nursing care was done by Ms. Inbanila and Ms. Mutulakshmi.
Talking about the increasing risk of Kidney failure in Children, Dr. Balasubramaniyam said, “Once the child is identified to have chronic renal failure in the initial stages, the aim of treatment consists of controlling the diet, controlling the blood pressure, aiding the bone growth, maintaining the hemoglobin and acid base equilibrium. But once the kidney failure reaches an advanced stage we should do pre-emptive kidney transplantation.
“In an adult we can wait for the kidney failure to become too advanced and plan for kidney transplantation later. But, in children we should do transplant early, because the child with kidney failure will start having growth retardation and bone changes that may become permanent. Also, it is difficult to do dialysis in a child, who is going to be increasingly non co-operative to treatment.”
Elucidating further on the procedure of Kidney transplantation, “Family counselling is done to make the parents understand the need for early transplantation before the child gets into advanced stage. This is the biggest task, as most parents will try alternative system of medicines to see if the child can be cured without undergoing a major surgery. Once the family is convinced of the need, then normally one of the parents will volunteer to be the kidney donor.
“The transplant surgery generally involves removal of a kidney from a donor and keeping it inside a recipient. Here the donor is an adult and the recipient is a child. Technically it is difficult to keep the adult kidney inside a child’s body. At the time of surgery the donor kidney blood tubes are bigger than the child and this warrants the kidney to be kept inside the abdomen, close to the vital organs and connections are even made to greater blood vessels (aorta and inferior vena cava) instead of the normal practice of external iliac blood tubes, says Dr. Jeevagan, Transplant surgeon and Urologist, Kauvery Hospital.
He adds, “Once the blood tubes of the adult kidney are connected to the child’s body when you allow the blood flow to resume in the kidney inside the child’s body the adult kidney can hold most of the child’ blood and the child could develop dangerous low blood pressure. Also soon after the surgery the adult kidney will start passing litres and liters of urine and the child’s blood volume is smaller and if not properly managed the child will drop the blood volume and kidney failure or disturbances in acid base balance and electrolyte balance can go haywire. The Nephrologist plays a big role in this situation to maintain all the parameters.
“Post-operative period pain management is crucial that decides the child’s co-operation. Also, the immune system of the child has to be suppressed to make the kidney acceptable. The kidney is foreign object inside the recipient and the natural tendency of the recipient’s immune system is to reject the kidney. To make the kidney function, immuno suppressive medications are given that makes the kidneys not to get rejected on one side, at the same time make the child vulnerable to infections. In a pediatric transplantation we need to give doses of these drugs in a careful manner because of the child’s immune system is working against an adult kidney. Subsequently the long term care of the child involves careful monitoring of the kidney functions, looking for possible infections, maintaining the doses of immuno suppressive drugs”, he further added.
Dr. Aravindan Selvaraj, Executive director, Kauvery Hospital said, “When compared to adult renal transplantation, very few happen in children, because transplantations in children require much greater expertise. Some children are born with congenital abnormalities of the urinary tract that lead to recurrent urinary infections and kidney failure. The kidneys also fail due to large quantities of protein leakage in the kidneys called Nephrotic syndrome and this will lead to kidney failure especially when the children don’t respond to treatment.”
Not many children are identified with the problems, the awareness that pediatric transplantations can be performed is still limited and not many centers can successfully perform pediatric transplantation.” He lauded the entire team of Doctors and Nurses for their efforts towards saving the lives of these two children.
Dr R. Balasubramaniyam, Chief Nephrologist – 90470 66640