Treatments and Procedures

Your First Visit

Your family's first step in the journey toward kidney transplantation is a full evaluation by our transplant team. You will learn about:

• The types of kidney transplants that we perform and what the transplant process entails.
• What you need to know if you are interested in donating a kidney to your child.
• What you'll need to do if your child is placed on the waiting list for a kidney from a deceased donor. You'll need to be reachable 24/7 and able to bring your child to the hospital quickly if a donor kidney becomes available.
• What your child's life will be like after transplantation. Your child will need to take medications and receive lifelong medical follow-up care to stay healthy.

Your child will undergo a series of tests to evaluate his or her health in preparation for the transplant process. The team will also let you know what you can do to help your child stay as healthy as possible before the transplant takes place.

Getting Ready: Surgery Before Transplant

As many as one in four children who need a kidney transplant have a pre-existing problem with the urologic system. These include children with:

• Posterior urethral valves (extra flaps of tissue that grow over a boy's urethra)
• Anorectal malformations (abnormalities)
• Cloacal disorders
• Neurogenic bladder (lack of bladder control due to a brain, spinal cord, or nerve condition)

These disorders can lead to serious kidney disease in early childhood. They are often diagnosed in unborn infants during prenatal care. Our pediatric urologists and transplantation surgeons work together to meet each child's needs before transplant, performing surgery that may enhance the chance of a successful outcome after transplantation by correcting anatomical abnormalities before the transplant.

Learn About the Types of Transplants

Our goal is to obtain the best matched kidney available for your child as soon as possible. We have found new ways of expanding the donor pool, increasing the number of kidneys available for transplants, addressing the shortage of healthy organs, and reducing waiting times for organs. Our transplant teams are also skilled in transplanting adult kidneys into children. These larger kidneys have more reserve and usually function better than pediatric donor kidneys.

Kidney transplantation options include:

• Donation of a kidney by a living donor. We routinely perform transplants of kidneys donated by living donors laparoscopically, using very small incisions and facilitating a more comfortable and faster recovery.
• Paired donor exchange. In a paired donor exchange, also known as a "kidney swap," two kidney recipients essentially "swap" willing donors. By agreeing to exchange recipients — giving the kidney to an unknown, but compatible individual — the donors can provide two patients with healthy kidneys where previously no transplant would have been possible. The first donor exchange was performed at NewYork-Presbyterian in 2004.
• Incompatible living donor. We may use this approach if a willing compatible kidney donor cannot be found. The recipient's blood must be repeatedly "cleaned" of mismatched antibodies through a process known as plasmapheresis.
• Deceased kidney donor. We reserve this approach for children who cannot wait for a suitable live donor.

Life After Kidney Transplantation

Your child's team will teach you how to care for your child after the kidney transplant. It is very important that your child takes all medications as prescribed and takes measures to reduce the risk of infection, which is elevated in transplant recipients because of the medications they take to prevent organ rejection. After-transplant care includes:

• Follow-up clinic visits
• Reducing the risk of infection
• Contacting your child's doctor promptly if you see signs or symptoms of an infection or rejection of the new kidney
• Following our recommendations regarding hydration, nutrition, exercise, and travel