What happens before the operation?

Your child’s kidney team will give you lots of information about the transplant operation and can answer any questions you might have. They will ask for your written agreement (consent) for the operation to take place.

The transplant will take place in a paediatric nephrology unit - a specialist hospital department for children’s kidney care.

You will be told when to come into hospital and where to go. You will meet the transplant nurse (or transplant coordinator), who will you give information and support before, during and after transplantation, and organise the timing of your child’s surgery. You will also meet the transplant surgeon, who will lead the team that carries out your child’s surgery. Your child’s paediatric nephrologist will continue to manage your child’s care.

You will be told when your child has to stop eating or drinking. It is very important that your child has an empty stomach during the transplant operation to reduce the risk of vomiting and help to prevent any damage to their lungs when they are under the general anaesthetic.

What does a kidney transplant operation involve?

The transplant operation is carried out under general anaesthetic, so your child will be asleep throughout and will not be in any pain. The operation usually lasts around four to six hours.

When your child is asleep, a surgeon will make a cut into their abdomen. The new kidney is inserted into your child’s lower abdomen and connected to an artery and vein in their pelvis so that blood can flow in and out. The new ureter will be joined to the bladder, so that urine can flow from the new kidney into the bladder. A short piece of soft plastic tubing called a stent is placed inside the ureter to help the connection to heal. The stent will be taken out a few weeks after the transplant surgery.

Your child will usually only be given one new kidney.

The transplant procedure is designed so that the new kidney can start working and making urine as soon as your child’s blood starts flowing through it. However, sometimes the new kidney is ‘sleepy’ and takes a while to start working once it has been transplanted. Your child may need a short session of dialysis if this happens. Most kidney transplants start working within a week of the operation.

Your child’s own kidneys are usually left in place unless they are infected or have grown too large for a new kidney to fit in (for example in conditions like ADPKD).

What happens afterwards?

Your child will be taken to the high dependency area of the children’s kidney ward or to a separate high dependency unit to recover from the operation. Sometimes, children need to be taken to the paediatric intensive care unit, especially if they are very young or if there are any complications during the surgery.

Your child will have lots of tubes in place that were put there during surgery. These help monitor your child’s blood pressure and how much fluid (liquid) is in their body. They also allow medicines to be given and blood to be taken, support your child’s breathing, and collect urine using a urinary catheter (a thin, flexible tube) that drains urine from the bladder. The transplant surgeon will decide when the catheter should be removed - this is usually four to seven days after the operation. Some children need a wound drain, which collects any extra fluid from the surgery – this is removed after several days.

Your child will be given medicines to relieve pain after the surgery. If they are old enough, your child may be allowed to control how much pain medicine they get themselves by pressing a button that gives the medicine through a cannula (a plastic tube inserted into a blood vessel in their arm). Your child will not be able to give themselves too much medicine. Your doctor or nurse will give you more information about this.

The time spent in hospital varies but the average is between one and two weeks. Your child will be discharged when staff are happy that they are safe to go home.

If your child receives a kidney from a living donor, the amount of time they spend in hospital is usually shorter than if they receive a kidney from a deceased donor. This is because kidneys from living donors are usually healthier than those from deceased donors, so they tend to start working in the recipient sooner.

Your child will be prescribed immunosuppressant medication to stop their immune system from seeing the new kidney as ‘foreign’ and rejecting it. Your child will need to take these medications for the rest of their life. It is vital that you understand the instructions for taking these medicines before you leave the hospital. Missing a dose of the tablets for 24 hours can cause rejection and your child may lose the kidney.

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