ORGAN TRANSPLANTATION IN CHILDREN

Frequently Asked Questions About Organ Transplantation in Children

How important is early diagnosis of kidney diseases in children?

Early diagnosis of kidney diseases in children, treatment and protection from relapse largely prevents irreversible damage to the kidneys and progression to kidney failure.

The kidneys and urinary tracts of healthy babies born at normal term have completed their development and can perform their functions completely. However, rarely, the kidneys of some babies may not develop at all in the womb or may remain small or malformed. Narrowness or urine leakage from the bladder to the kidneys (vesico/ureteral reflux) may also occur during the development of the urinary tract.

Is it possible to detect kidney diseases in the womb before the baby is born?

Diagnosis of kidney and urinary tract diseases in babies in the womb can be made starting from the third month of pregnancy with modern ultrasonography devices used today and deformities in the baby's kidneys and urinary tract can be seen. Ultrasonography examination can monitor whether the kidney tissue is developing normally and it may be possible to treat it before disease symptoms appear after birth and even in some special cases while still in the womb. In addition to structural disorders of the urinary tract, some hereditary (familial) kidney diseases can also be diagnosed in the womb with genetic tests.

How seriously should urinary tract infections be taken in children, what are their symptoms?

Urinary tract infections are a common condition in children. The infection can remain limited to the bladder (cystitis) or in some cases, it can spread to the kidneys (pyelonephritis). Symptoms such as frequent urination, burning and pain during urination, urinary incontinence, sometimes bleeding urine and mild fever occur in urinary bladder infections. In upper urinary tract infections, the fever is often higher and flank pain can also be observed. Urinary tract infections should be diagnosed and treated in a timely manner and an underlying structural disorder should be investigated. If there are diseases such as cysts, stones, stenosis in the kidneys or urinary tract, or if there is a disorder in the bladder or reflux, the risk of infection increases. Timely diagnosis is possible by taking mild complaints about urination in children seriously.

What is nephritis, what are its symptoms?

Nephritis occurs as a result of the accumulation of some substances and cells that normally serve in the body's defense system in the kidney tissue. There are two main types of nephritis:

Acute nephritis is a common disease in children. It is seen after tonsil and skin infections. Bloody urine and swelling in the eyelids, face and legs, increased blood pressure and temporary kidney failure may occur.

Chronic nephritis sometimes starts insidiously without any symptoms; in some patients, bloody urine and swelling in the body may be seen.

What other diseases can cause kidney function deterioration in children?

Nephrotic syndrome is a disease characterized by protein loss in the urine and swelling in the body. Its causes vary according to age groups in children. There are types that progress with recurrences and do not cause chronic kidney failure, as well as nephrotic syndrome types that cause chronic kidney failure in a short period of time.

Some diseases such as Familial Mediterranean Fever, Hemolytic Uremic Syndrome, Diabetes and Lupus also cause chronic kidney disease.

Is it possible to protect children from kidney diseases?

It is possible to completely prevent some of the kidney diseases seen in children with the precautions we will take. For example, we can prevent the emergence of acute nephritis by reducing tonsillitis in the society with general health measures.

It is not possible to completely prevent congenital structural disorders, chronic nephritis or nephrotic syndrome. However, in these cases, the disease can be treated or at least its progression can be stopped with early diagnosis. For example, if regular ultrasound checks are performed during pregnancy, kidney and urinary tract disorders can be recognized while the baby is still in the womb and the necessary precautions can be taken. In addition to stopping the recurrence of infections by treating urinary tract infections without neglecting them and investigating their causes, a process that will damage the kidneys and end with the complete loss of kidney function over time can be prevented by treating urinary tract strictures and reflux. In particular, meticulous attention should be paid to recurrent urinary tract infections.

What are the symptoms of kidney diseases in children in general? Can chronic kidney failure also occur in children?

Unfortunately, yes! In congenital kidney and urinary tract diseases, kidney stones, chronic nephritis or recurrence of kidney infections, the functioning of children's kidneys can also be impaired. Kidney failure can be acute or chronic. If this condition progresses too much, a condition we call 'end-stage renal failure' occurs; substances such as urea, creatinine, uric acid, salts and water accumulate in the body and threaten life.

In fact, chronic kidney failure can slowly take over the child's kidney like an insidious enemy and most of the time, when it is noticed, it has reached an irreversible stage, the child's kidney functions may be almost completely impaired. Especially in the early stages of the disease, there may not be very obvious findings, and the symptoms and complaints that do exist are often of a type that cannot be focused on or can be attributed to other causes. When looked at in general, it can be seen that the first symptom of the disease in almost all children who are sick is weakness, a state of fatigue that does not go away with rest. The child does not have the same activity as his peers, and has difficulty keeping up with them. He/she gets tired easily and is unmotivated while playing, running or doing sports. There is also a general loss of appetite. With these insidious findings that occur in the early stages of the disease, it is very difficult for the child's parents to think of a possible kidney disease. As the disease progresses and kidney functions deteriorate more and more, more striking symptoms begin to emerge. The child may experience nausea, vomiting, persistent itching, widespread bone pain, shortness of breath, and swelling in the eyelids and legs due to fluid accumulation in the body. When this period is reached, symptoms such as decreased urine volume, frequent urination, nighttime incontinence, and bloody or cloudy urine, which suggest that the problem may be related to the kidneys, also appear. Kidney deterioration at this level begins to upset all balances in the body. The child's growth and development stop, they do not grow taller, and the sexual development process lags behind. The fact that depression and introversion often accompany the deterioration of the child's learning capacity and concentration, seriously negatively affects the child's success in school. If treatment is not started, children may experience seizures, lung and heart problems may occur, consciousness may be lost, and even the child may die as a result of sudden cardiac arrest.

When the child's kidneys cannot meet the needs of the body, dialysis treatment must definitely be started or a kidney transplant must be performed. Today's technical developments have made it possible to apply dialysis and kidney transplantation to children. Dialysis treatment can be performed in two ways: machine dialysis (hemodialysis) and peritoneal dialysis (peritoneal dialysis). However, under normal conditions, our kidneys are like machines that work 24 hours a day without a break, just like our hearts. However, with the help of a device used in dialysis treatment, water and harmful waste materials that accumulate in the body for a few hours on certain days of the week are tried to be removed. During the hours and even days when the dialysis machine is not connected, these substances and water accumulate in the patient's body, meaning that although dialysis is definitely a life-saving treatment, our kidneys can only partially fulfill their function. For this reason, it is only possible to partially prevent the complaints we have listed above in children who start dialysis treatment.

Can a kidney transplant be performed in children?

The best treatment for children with end-stage renal failure is kidney transplantation. All children without acute or chronic active infection or tumoral disease are suitable candidates for kidney transplantation. Today, it is possible to perform kidney transplantation on young children and even infants.

When should kidney transplantation be performed on children and why?

In every possible child, kidney transplantation should be performed before starting dialysis treatment; in order to prevent systemic disorders that may occur due to dialysis in children, to prevent the child's growth from being delayed, to ensure normal social and psychological development and to maintain hormonal balances especially during adolescence. The growth development of children with end-stage renal failure also stops, this developmental delay becomes much more obvious as the period increases, and this physical developmental delay inevitably brings about problems in the child's social and school life. However, after a successful kidney transplantation, the child's growth and development begin to be visibly noticeable in a very short time, and the shorter the time lost, the easier and faster it is for the child to catch up with his/her own age group. Moreover, compared to other treatment methods such as hemodialysis or peritoneal dialysis, organ transplantation offers patients both a much longer and higher quality of life. The life expectancy provided to the patient with kidney transplantation is approximately 3 times longer than with dialysis. After kidney transplantation, the restrictions on fluid and food intake imposed on children before transplantation are eliminated, they regain their human rights such as eating, drinking, playing, going on vacation, and the same things as their peers. They can live their childhood and adapt to school life and society much more easily.

Is kidney transplantation to be performed on children different from adults?

In the past, in order to perform kidney transplantation on children, it was expected that the child would be at least 2 years old, gain some weight and grow, but with the surgical experience gained today, it has become possible to perform kidney transplantation on much younger babies. Here, it may be necessary to use some different techniques in placing the adult kidney in the child's body. For example, while the transplanted kidney is normally placed outside the peritoneum in the patient's groin area and its veins are connected to the veins going to and returning from the leg, especially in young children, the kidney may not fit in this area and the very thin vein sizes may cause problems. For this reason, it may be necessary to place the kidney inside the peritoneum and use the larger main veins.

Who can donate kidneys to children?

In organ donations made from deceased people, if the donor is in the childhood age group, the priority for using these organs for child patients is given, in which case the problem with the size of the organ is automatically eliminated. However, in our country where organ donation rates are far below the need, living donors are generally used. Our current laws allow blood and in-law relatives up to the 4th degree to be organ donors, and in cases where there is no consanguinity, living donors can be used provided that ethics committee approval is obtained. When we look at the patients in whom we perform kidney transplantation in the childhood age group, it is seen that living donors are used in approximately 90% of the cases. Approximately 63% of the donors are mothers and 30% are fathers, but it is seen that other relatives of the child are donors in 6% of the cases. Anyone over the age of 18 can be a candidate for living kidney donor for patients in the childhood age group.

What is the most common cause of chronic renal failure in children in our country?

While the most common cause of end-stage renal failure in the childhood age group in our country is infections, some genetic diseases can also cause this result. This problem can be encountered more frequently, especially in regions where consanguineous marriages are common. In such a case, the same problem may occur in more than one child in the same family. In a family where both siblings have chronic renal failure, the necessary tests and evaluations are performed between the living donor candidates and the children, especially the blood type, and the decision is made as to which child will be given priority for transplantation by evaluating many factors such as the children's developmental status, the importance of complications due to dialysis, and the duration of dialysis.

What are the difficulties of the process after kidney transplantation in children?

In transplanted patients, the patient's immune system perceives this new organ placed in the body as an attack and does not want to accept it, it starts to fight it, which is why organ transplant patients must use a treatment that will suppress their own immune systems for life. With the drugs developed to date for this purpose, it is possible for the transplanted organ to function without problems for years. However, at this point, when it comes to pediatric patients, the communication between the doctor and the family and the family's harmony are extremely important. Since children do not take these drugs on their own, the sensitivity and sense of responsibility of the family directly determine the success of the treatment. Failure to use the drugs regularly and in the specified doses and failure to perform regular check-ups may result in the transplanted kidney losing its functions.

If the transplanted kidney becomes unable to perform its functions, can another kidney transplant be performed on the same patient?

If the organ loses its functions over time, a second, third or even more kidney transplants can be performed on the same patient if necessary.

What can be said lastly for patients waiting for a kidney transplant?

It should not be forgotten that in Turkey, there are not only those waiting for kidneys, but also many people and children waiting for vital organs such as liver and heart, or face transplants, who have no other treatment options, and whose lives depend on organ donations. Before waiting for such an event to happen to ourselves or a loved one, we should remember our social responsibilities, one day we too may be in the shoes of that patient or that helpless patient's relative. Therefore, let the fire not burn where it falls, if we all feel the presence of that fire in our hearts, do our part to extinguish it, and donate our tissues and organs, our organs that will rot and disappear in the ground after we die can be a source of life for these patients and these children who are waiting with hope.

The information contained within the site is for support purposes only. It does not replace a physician's examination, diagnosis, and prognosis of a patient for medical purposes.

Copyright © 2023 Prof. Hamdi Karakayalı, M.D. All rights reserved. | Powered by Mad Men Agency, MMA