Evaluating and Preparing the Pediatric Dialysis Patient for Kidney Transplantation

Abstract

Renal transplantation is the treatment of choice for childhood end-stage renal failure as it leads to substantially reduced patient morbidity and mortality rates compared to chronic dialysis. As such, referral and evaluation for kidney transplantation should occur promptly once a child reaches advanced stages of kidney disease. Absolute contraindications to transplantation in childhood are very rare: florid infectious diseases, malignant diseases that cannot be treated curatively, and serious concomitant disorders that challenge the success of transplant surgery. Thus, the focus of the kidney transplantation evaluation is generally not to determine whether a pediatric transplant candidate is eligible for transplantation or not. Rather, the purpose of the pediatric transplant evaluation is to identify any potentially modifiable surgical, medical, and psychosocial barriers that may adversely impact optimal patient and graft survival. To this end, a robust, multi-disciplinary approach is essential to promote safe and effective transplantation for children and their families. This chapter describes the multi-faceted transplant evaluation for a child with end-stage renal disease, explains the rationale, and suggests best practices to optimize pediatric kidney transplant access and outcomes.