Kidney Transplant Success With Even The Smallest Children

As dramatic transformations go, it’s hard to match the aftermath of a sick child’s kidney transplant. Freed from dialysis and the side effects of kidney failure, young kidney recipients experience bursts of growth, discover new reservoirs of energy and achieve developmental milestones.

In 2012, caregivers at Lucile Packard Children’s Hospital enabled this exciting process dozens of times: They performed 31 kidney transplants in kids under age 18, more than any other pediatric transplant program in the nation. That’s according to newly released data from the United Network for Organ Sharing, the private, non-profit organization that manages the nation’s organ transplant system.

“We have very high success rates with difficult-to-transplant children, those who are too small or too sick to be treated in other places,” said Packard Children’s pediatric nephrologist Paul Grimm, MD, the kidney transplant program’s medical director. “We want all of these kids to have the best possible chance for a normal life.”

The team’s success with very sick kids is due to a multipronged approach that surmounts many obstacles to transplant. The work begins long before the day of surgery, continues for years afterward, and draws on a diverse array of experts, including physicians and surgeons, nurse coordinators, nurse practitioners, physician assistants, nutritionists, child-life specialists, social workers and psychologists. “We have a fantastic, dedicated team of people who live and breathe transplant,” Grimm said.

One common barrier to transplant is the small size of the youngest patients — 33 pounds is often considered the lower threshold for kidney transplant. But Packard Children’s team can transplant kids as small as 22 pounds, thanks to the team’s special surgical expertise.

The smallest patients benefit from several improvements in care that the Packard Children’s team has instituted to help them. Before transplant, optimal nutrition helps them grow as strong as possible in preparation for their surgeries. Dialysis treatments are provided by nurses who specialize in giving dialysis to infants and small children. After transplant, caregivers carefully monitor patients’ fluid levels and blood pressure to make sure that the kidneys they receive function correctly.

“One thing that makes our smallest patients do so well is that we try to get the biggest, healthiest kidney possible into their little bodies,” Grimm said.

Based on decades of pioneering Packard Children’s research, patients also receive a regimen of immune-suppressing drugs that avoids steroids, which were once considered essential but stunt children’s growth. Steroid-free immune suppression is now standard for all of Packard Children’s kidney recipients. Nationwide, about half the kids who receive kidney transplants now receive steroid-free medication for immune suppression.

In addition to helping first-time kidney recipients, the Packard Children’s team has special expertise in performing second transplants for children whose bodies have rejected the first one. “These children are often considered un-transplantable by their local transplant centers because their immune systems are so hyperactive, and they can languish on dialysis,” Grimm said. Unlike many other transplant programs, Packard Children’s can offer medication to lower the body’s sensitivity to transplanted tissue, he added. “Our desensitization program can allow us to transplant them and help them return to more normal lives.”

For the transplant team, the best part of their jobs is watching patients’ development after they receive new kidneys.

“They thrive,” transplant coordinator Gerri James, RN, said. “They become like every other kid at the playground. You really make a difference in their lives. Nothing else can come even close to that feeling.”