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Center for Pediatric Transplant and Advanced Kidney and Urologic Diseases Established at the Phyllis and David Komansky Center for Children's Health

New York (Apr 29, 2010)

Father and Son

Children and adolescents suffering from kidney and urologic diseases, including those who may need a kidney transplant, can now find comprehensive care through the Center for Pediatric Transplant and Advanced Kidney and Urologic Diseases, recently established at the Phyllis and David Komansky Center for Children's Health. The Center's pediatric nephrologists and urologists offer expertise in the diagnosis and treatment of rare and progressive conditions that can lead to end-stage renal disease in children, as well as kidney and bladder malformations in infants and toddlers. They provide medical and surgical care for patients - from newborns to young adults - with outcomes ranked among the nation's best.

Our Expertise

The multidisciplinary transplant program crosses several specialties, with a healthcare team comprised of transplant surgeons, pediatric nephrologists and pediatric urologists, as well as pediatricians, psychiatrists, nutritionists, social workers, and pharmacists. Using this team approach, the Center is able to provide continuity of care to patients and their families throughout the length of the child's illness and treatment, pre- and post- surgery. Patients and family members also receive transplant counseling throughout the process - from the decision to transplant through recovery. A transplant coordinator will manage appointments and testing so that patients and families receive seamless care from the physicians and health professionals they have come to know.

Our pediatric nephrologists manage the kidney disease of children during the period that precedes and up to the time that they receive a kidney transplant, should that be necessary. Our aim is to manage the child with the goal of preventing the need for kidney transplantation. In other cases, we may be able to prolong the kidney's ability to function.

Very young children with end stage renal disease who might be too small to be considered for transplantation are generally placed on peritoneal dialysis since it can be done at home at night while the child and family sleeps. Peritoneal dialysis involves placement of the catheter into the abdominal cavity, making access easier than for hemodialysis, which requires access through a vein. Newborns can also start peritoneal dialysis at birth.

For school-aged children, peritoneal dialysis helps to normalize their lives, enabling them to attend school full-time and participate in their usual activities while getting treatment for kidney failure. Hemodialysis, which is recommended for children who are older, is performed at the Hospital or in a dialysis center. Since hemodialysis can be a three-hour procedure performed several times per week, volunteers or child life specialists are often available to interact with the children during this time.

Our pediatric urologists work very closely with the pediatric nephrologists to help optimize bladder function in children who are going to have a kidney transplant. Optimizing bladder function - with medication or with surgery - helps to prolong kidney function. Our pediatric urologists can perform reconstructive surgery in children who have lost their kidney function, but also have dysfunctional bladders, to prepare them to receive the transplant.

Innovations in Kidney Transplantation

The Center for Pediatric Transplant and Advanced Kidney and Urologic Diseases draws on the expertise and resources of the NewYork-Presbyterian/Weill Cornell Transplant Program - the first kidney transplant program established in New York State. The Transplant Program has performed over 3,000 kidney transplants; more than 200 kidney transplants are performed each year. Since 2006, NewYork-Presbyterian/Weill Cornell has had one of the highest volume transplant programs in the country, made possible through advances such as kidney swaps and blood-type incompatible procedures that have revolutionized live organ donor transplantations. The kidney transplant program offers the latest transplant management protocols and surgical interventions with lower rejection rates and higher adult graft survival rates as compared to national outcomes.

In 2008, the transplant team at NewYork-Presbyterian/Weill Cornell successfully performed one of the nation's first never-ending altruistic donor (NEAD) "chain" renal transplants. In a NEAD chain, patients with blood type or crossmatch incompatible living donors are entered into a registry, where they are matched with more suitable living donors. The innovative NEAD approach may forever change the way transplants are performed in the United States.

The dedicated team of physicians and surgeons in the Transplant Program is responsible for many significant advances made over the past several decades in transplant surgery and the maintenance of healthy organs. They have been at the forefront of developing and improving:

  • minimally invasive surgery for living donors
  • non-invasive methods to detect transplant rejection
  • strategies to increase opportunities for living donor transplantation
  • islet cell transplantation
  • anti-rejection medication combinations
For the first time in the history of kidney transplantation, physicians are able to individualize the medication regimen used to suppress the immune system and reduce the amount of exposure to these medications by utilizing molecular tools developed at NewYork-Presbyterian/Weill Cornell.

By applying new surgical techniques and approaches to expand the donor pool, the Center for Pediatric Transplant and Advanced Kidney and Urologic Diseases continues to make strides in pediatric kidney transplantation. A very active Living Donor Program enables the Center to offer pre-emptive kidney transplantation (transplant prior to needing dialysis). The transplant team is also skilled in transplanting adult kidneys into children. These larger kidneys have more reserve and usually function better than pediatric donor kidneys.

Resources for Patients and Families

For more information on kidney transplant, please visit the following websites:

Faculty Contributing to this Article:

Valerie Johnson, MD, PhD, Chief, Pediatric Nephrology, Phyllis and David Komansky Center for Children's Health, NewYork-Presbyterian/Weill Cornell, and Associate Professor of Clinical Pediatrics, Weill Cornell Medical College

Sandip Kapur, MD, Chief, Division of Transplantation Surgery and Director, Kidney and Pancreas Transplant Programs, NewYork-Presbyterian/Weill Cornell, and Associate Professor of Surgery and G. Tom Shires, M.D. Faculty Scholar in Surgery Weill Cornell Medical College

Dix P. Poppas, MD, Professor and Chief of the Institute for Pediatric Urology, Phyllis and David Komansky Center for Children's Health, NewYork-Presbyterian/Weill Cornell, and Richard Rodgers Professor of Pediatric Urology, Weill Cornell Medical College

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