The Transplant Center
Kidney Transplant
The Pediatric Kidney Transplant Program at Primary Children's Hospital is a collaborative effort with the University of Utah Kidney Transplant Program.
We provide specialized pediatric inpatient care along with substantial outpatient resources and supportive services important to transplantation medicine. Patients continue to be followed by the multidisciplinary pediatric transplant team at regular intervals until transitioned to adult transplant care. Our program provides transplantation for an average of 15 transplants per year.
What Sets Us Apart
Multidisciplinary Care
Excellent Outcomes
Patient & Family Centered Care
Learn more about our patient and family support services >
Steroid Free
Since 2000, our program has not used maintenance steroids as part of the immunosuppressive regimen, benefits of which include:
- Specific benefits to children with growth potential
- This approach has resulted in nearly universal and immediate "catch up growth" in pediatric renal transplant recipients with remaining growth potential.
- No statistical increased incidence of rejection relative to children treated with maintenance steroids at this institution or relative to outcomes at other programs.
- Improved bone health and lipid profiles
School Re-Entry Program
We are committed to helping patients transition back to their normal lives, including school.
- Our program is unique in that it involves the same full multidisciplinary team which follows the patient pre- and post transplant. This team transitions the child back to school after transplantation.
- With the approval of the family and school, the team goes to the child's class to educate teachers, classmates, etc. regarding all relevant aspects of transplant.
Pediatric to Adult Transition Program
Adolescents and young adults are most vulnerable during transfer from the pediatric setting to adult care. Children who received a transplant at a very young age may not have a good understanding of their chronic condition and may also be more dependent upon the adults in their lives for their care.
The goal of our transition program is to prepare these adolescents and young adults and parents/guardians for a successful transfer to adult care through a comprehensive patient-centered and developmentally appropriate transition program. Completing a transition program should enable our patients to achieve self-efficacy and optimize their independence to provide self-care to the best of their ability.
- This is important because of the very high risk of organ loss within the first few years of transfer to adult care.
- Our approach includes ongoing education, involvement of a dedicated transplant staff, appropriate involvement of the family, and the provision of progressive responsibility to the young patient.
- Multidisciplinary discussions regarding the progress and appropriateness of transition to adult care occur at regular intervals.
Recognition & Accreditation
- Member and participant of American Society of Nephrology
- Pediatric Transplant Committee Member - United Network for Organ Sharing
- Medal of Honor - U.S. Health Resources & Services Administrations National Collaborative on Organ Donation and Transplantation.
- Optum Center of Excellence
- Recognized as a Best Children's Hospital by 2023-24 U.S. News & World Report in pediatric nephrology
Meet the Team
Nephrologists
Nephrologists are doctors who treat kidney disease. A nephrologist will help decide if transplant is needed, manage the patient's health problems before and after kidney transplant surgery, prescribe medications after surgery and consult other doctors for health concerns not related to the kidney.Transplant Surgeons
Our team consists of specialized transplant surgeons who will help decide if a transplant is needed, perform the kidney transplant surgery, manage patient recovery right after the surgery and during the patient's hospital stay, including monitoring and taking care of the incision.What to Expect
Kidney Transplant Evaluation
We encourage you to ask questions and learn as much as possible about the transplant process before making a decision. You do not need to reach a decision by the end of the session.
Screening Tests
Regardless of the type of kidney your child may receive — from a living donor or a deceased donor — special blood tests are needed to determine your child's kind of blood and tissue. These test results help to match a donor kidney to your child.Blood Type Testing
The first test is to see your child's ABO blood type. There are four blood types: A, B, AB and 0, and everyone fits into one of these groups. The recipient and donor must have either the same blood type or compatible ones. The list below shows compatible types.
- If your child's blood type is: A (The donor blood type must be: A or O)
- If your child's blood type is: B (The donor blood type must be: B or O)
- If your child's blood type is: AB (Universal recipient - The donor blood type must be: A, B, AB, or O)
- If your child's blood type is: O (Universal donor - The donor blood type must be: O)
Patients with AB blood type, called the universal recipient, are the easiest to match because they accept all other blood types. Blood type O, called the universal donor, is the hardest to match. Although people with blood type O can donate to all types, they can receive kidneys only from blood type O donors. For example, if a patient with blood type O were given a kidney transplant from an A donor, the recipient's body would recognize the donor kidney as "foreign" and destroy it.
The Rh type (+, -) is not a factor in donor matching.
Human Leukocyte Antigens (HLA)
The second test, which is a blood test for human leukocyte antigens (HLA), is called tissue typing. These antigens are substances found on many cells of the body, but are mostly seen on white blood cells. Tissue type likeness between family members may be 100, 50 or 0 percent. The tissue type of all potential donors is considered in donor selection.
The prospective recipient and family members and non-relatives interested in donating a kidney can make arrangements with the transplant team for tissue typing. No special preparation is required, and results are available within 2 - 3 weeks. Pre-packaged kits with instructions about how to collect and return blood samples are available to mail to out-of-town relatives. The necessary blood can be drawn at a local physician's office or hospital laboratory and sent back to us via overnight mail.
Crossmatch
Throughout life, our bodies make substances called antibodies that destroy foreign materials. We may make antibodies each time we have an infection, have a blood transfusion or undergo an organ transplant. If your child has antibodies to the donor kidney, the kidney will be destroyed. For this reason, we conduct a test to ensure that your child doesn't already have antibodies to the donor when a donor kidney is available. This test is called a crossmatch.The crossmatch is done by mixing your child's blood with cells from your donor. If the crossmatch is positive, it means that your child has antibodies against the donor and should not receive this particular kidney. lf the crossmatch is negative, it means your child doesn't have antibodies to the donor and is eligible to receive this kidney.
Crossmatches are obtained several times during preparation for a living-related donor transplant, particularly if donor-specific blood transfusions are used. A final crossmatch is performed within 48 hours before the transplant.
Serology
Testing is done for potentially transmissible diseases, such as HIV (human immunodeficiency virus), hepatitis and CMV (cytomegalovirus).Transplant Waiting List Placement
Once the evaluation is complete, the transplant team will meet and a decision is made whether or not to place your child on the transplant waiting list. This decision is made only after discussing each case with the nephrologist, surgeon, transplant coordinator, social worker and financial counselor. You will be notified when your child's name is placed on the national transplant waiting list. If a transplant isn't in your child's best interest, a transplant team member will call and discuss other options with you.Living Donor Testing
Kidneys for transplantation come from either a living donor or a deceased donor. When a living person donates a kidney, his or her remaining kidney will enlarge as it takes over the work of two kidneys. As with any major operation, there's a chance of complications, but kidney donors have the same life expectancy, general health, kidney function and activities as most other people. Any healthy person can donate a kidney. Sometimes a family member or close friend may wish to donate a kidney. A donor must be in excellent health, well informed about transplantation and able to give informed consent.If you have a potential living donor, he or she will meet with a transplant surgeon and a transplant coordinator during the evaluation process to discuss the possibility of organ donation. We will perform tissue typing and other tests to determine if the potential donor is suitable. In some families, several people may be compatible donors. In other families, none of the relatives or non-relatives may be suitable.
Kidney Transplant Procedure
Living Donors
Our living donor surgeries are done through a procedure called laparoscopic donor nephrectomy. This procedure uses tiny incisions and miniature instruments to remove the kidney. Our team has performed more than 60 of these procedures since 1999.Most laparoscopic nephrectomy patients stay at the hospital only two or three days after the surgery, compared to four or five days for a conventional nephrectomy. The laparascopic procedure is just as safe for both donor and recipient, and recovery is easier for the donor. Laparoscopic nephrectomy is now offered to any patient who meets the physical requirements.
Deceased Donors
A deceased kidney comes from a person who has died. The Uniform Anatomical Gift Act allows all of us to consent to donate organs when we die and allows our families to provide such permission as well. After permission for donation is granted, the kidneys are removed and stored until a recipient has been selected. All donors are carefully screened to prevent any disease transmission.If you want your child to undergo a deceased kidney transplant and this is a medically acceptable option, your child's name will be placed on a deceased waiting list. A sample of blood for antibody level is sent monthly to the medical center. The waiting period for a deceased kidney depends upon the availability of a deceased donor compatible with your child's blood type and antibody level.
When a kidney becomes available, you will be contacted. The transplant team will verify that your child has no recent infections or medical problems that would interfere with safe transplantation. The transplant team will tell you when a deceased kidney is available and will assist in planning for your transplantation.
Transplant Surgery
Your child's surgery may last from two to over four hours. In children weighing over about 45 pounds, the kidney is placed in the pelvis rather than the usual kidney location in the back. Your child's own kidney will usually remain undisturbed. The artery that carries blood to the kidney and the vein that removes blood from it are surgically connected to two blood vessels already existing in the pelvis. The ureter, or tube that carries urine from the kidney to the bladder, is also transplanted through an incision in the bladder. If your child is smaller, there is not enough room in the pelvis for the new kidney. In that case, the kidney is placed within the abdomen, requiring the intestines to be manipulated. The blood vessels of the kidney are connected to the main artery (aorta) and vein (vena cava) in the abdomen, and the ureter is connected to the bladder. Other procedures may be carried out during the transplant operation (such as removal of appendix, gall bladder, possibly your child’s own kidney or kidneys). This is a bigger specialized operation which will require a longer time for recovery.After the operation, your child will be taken to the recovery room for a few hours and then will return to the surgical ICU. The surgeon will inform you when the procedure is over. Your child will be encouraged to get out of bed 12 to 24 hours following surgery to walk around the unit as much as he or she can. Nurses will help teach your child how to take medications, about side effects and about nutrition guidelines after a transplant.
A deceased kidney will occasionally perform as a "sleepy" kidney, a condition called acute tubular necrosis, or ATN. This means that the kidney is temporarily slow in functioning. Your child may need dialysis a few times, which will not harm the kidney. The "sleepy" kidney usually starts working in two to four weeks.