Transcription:
UK HealthCare's Pediatric Transplant Program

Cheryl Martin: Dealing with your child's sudden or chronic illness can be challenging. And adding to anxiety is the unwelcomed news that your child needs an organ transplant. What do you need to know? Well, on this episode of UK HealthCast, a podcast sponsored by University of Kentucky Healthcare, you'll get some answers. We discussed the pediatric transplant program here at UK HealthCare. I'm Cheryl Martin. And our guest is Dr. Meera Gupta, surgical director of the pediatric kidney program. Thanks so much for being on, doctor.

Dr Meera Gupta: Oh, thanks for having me.

Cheryl Martin: Who are candidates for a pediatric transplant?

Dr Meera Gupta: Well, we at UK specialize in pediatric kidney transplantation and candidates for pediatric transplant include those children who suffer from end-stage renal disease, either through birth defects or hereditary diseases involving their kidneys, infections, nephrotic syndrome, other systemic diseases, such as lupus, Alports or HUS and trauma, as well as urine blockage or reflux.

Cheryl Martin: Doctor, explain the process if a transplant is needed. What does the child and the family have to go through to be approved?

Dr Meera Gupta: Of course. So the child will undergo a comprehensive evaluation with our pediatric kidney transplant team. It typically involves meeting with our multidisciplinary team that includes the surgeons, the nephrologists, the nurse coordinators and social workers and financial counselors, as well as other members of our team. It will also include some blood work and other medical tests to determine the child's eligibility for transplant and feasibility of the operation. After that, the committee will meet and review all of the testing and imaging for the child, as well as the consultations provided by each member of the team to determine if kidney transplant is a good option for the child.

Moving forward, once the child gets listed, there are options for transplantation, either through living donation or deceased donation. And that will be determined based on the preferences of the child and their family as well as their providers, the primary nephrologist. After that, then the patient is worked up and listed and will either undergo a deceased donor kidney transplant or a living donor kidney transplant that is typically scheduled.

Cheryl Martin: Typically, how long does it take when a child is on the list? Whether for a living or deceased, how long does this take before they can actually get a transplant?

Dr Meera Gupta: That time period varies a little bit depending on how well the child is. Many children who are listed for transplant are listed quite early, so they can accrue waiting time. And when the nephrologist feels that the child is ready for transplant on the deceased donor list, we will go ahead and activate them. And then, they do receive pediatric priority on the list and they are listed above all adults. So their waiting time is actually quite short. It's usually within a few months to a year, depending on how sensitized they are and how eligible they are. If it's a living donor, either through a family member or a friend or someone that they know they can have the living donor worked up and schedule the surgery within weeks to months of getting listed. If they go through a National Kidney Registry where they find a suitable pair to start a chain, if the donor and recipient are not compatible, that can take a little bit longer, but it's usually within a few months as well.

Cheryl Martin: Now, does the donor have to be a child or around the same age as the child receiving the transplant?

Dr Meera Gupta: No. So the donor can be someone of any age. We typically profile the donors based on their kidney donor profile index and choose ideal kidney donors for pediatric recipients. They're typically young adults, healthy, normal kidney function, and they can donate to a child through a living donation. We do not allow children to donate to other children through living donation. The children on the deceased donor waiting list are eligible for pediatric donors, although those are less common.

Cheryl Martin: How can parents prepare their children for this entire process?

Dr Meera Gupta: The process is quite involved. What we do is we get to know the child and the family quite well through several visits, so that they feel comfortable with our transplant team and essentially become part of our family since we follow them for a long period of time, as long as their kidney lasts.

In order to prepare for that, the parents can orient the child through our orientation platform, our videos and pamphlet information, and just let them know that they're going to be meeting and befriending a lot of people on our team. When they come in, like I said, they will have routine blood work and visits with every single one of our team members and have contacts with them and then follow up with us at interval time periods thereafter. After transplant, they will need to continue following up with us so that we can check on them and ensure that their kidney is doing okay.

Cheryl Martin: And how long is the surgery?

Dr Meera Gupta: The surgery for pediatric kidney transplantation typically takes about three to four hours. It involves the specialized pediatric transplant surgeon who leads the team in the operating room, the pediatric nurses and OR staff, as well as the pediatric nephrologist who will be helping with the patient's care before and after surgery.

Cheryl Martin: You touched on this a little bit about what life looks like post-transplant. Anything you want to add on that about what life looks like post-transplant for the pediatric patient?

Dr Meera Gupta: Yeah. So life actually gets better after pediatric transplantation. When a child suffers from renal disease, they have considerable delays in terms of their ability to clear toxins from their body, growth development, brain development, et cetera. So once the child gets out of the recovery phase of transplant, they actually do feel better, have more energy, they're eating better and they even grow more quickly. So what we can do to help the child and the family adjusts to pediatric transplant is adjusting and returning to school, helping with financial needs to pay their medical bills and afford their medicines that are necessary to prevent rejection. There's an emotional adjustment. For example, children start feeling better and want to socialize. So we can provide the family with some emotional support. We continue to follow the child with interval lab studies to make sure their kidney function and their immunosuppression levels are okay. Our dieticians will counsel the child and the family about what foods to keep the new kidney healthy and then regular exams with the nephrologist.

Now, as children get older, we also teach them how to manage taking their own medications and be active in their own healthcare, so that the kidney can last as long as we can get it to last. There are health education programs for kids and teens with kidney disease and transplants as well that we can offer contacts for.

Cheryl Martin: I'm glad you mentioned the kidney lasting as long as it can. So how long can the kidney last? A lifetime or should the kids expect to need another surgery in the future?

Dr Meera Gupta: Yes. So a kidney transplant in a child is likely to last decades if it is taken care of well. And if perfectly matched, it can last forever. Most kidneys are not a perfect match and we do expect individuals who get transplanted at a very young age to need another transplant later on in life.

Cheryl Martin: Okay. Why would you say UK HealthCare is the place for a pediatric transplant? Why UK HealthCare?

Dr Meera Gupta: Our UK Pediatric Transplant Team is committed to innovative care and strongly integrated support for every child and their family. It's important to know that transplantation is not a cure. It's a treatment option for kidney failure, and it does require a lifelong commitment to taking the medications and receiving consistent medical treatment. And the goals of our center are to give these children the best treatment for end-stage kidney failure, establish normal kidney function and allow for improved quality of life long-term. So these patients become our family and we remain committed to them. We want them to succeed. We want to ensure that they go back to what we all consider as normal so that they can grow normally and enjoy all aspects of normal life. And that's why I really feel strongly that we're the best option for kids in Kentucky.

Cheryl Martin: What else do you think sets UK HealthCare apart when it comes to pediatric transplant?

Dr Meera Gupta: I think our transplant team has a history of successful transplantation. UK Kidney Transplant has performed over 80 pediatric kidney transplants since it started. And our short and long-term outcomes are well above the national average. They're quite perfect, in fact. We offer both deceased and living donor transplantation for our children on the list and follow them very closely so that we obtain every option to get them transplanted as possible. We participate in the National Kidney Registry for living donation among incompatible donor recipient pairs and have a very strong relationship with local nephrologists and providers to build this multidisciplinary team and partnerships, so that patients continue to get comprehensive and collaborative care.

Cheryl Martin: Now, are there different requirements or regulations for pediatric programs?

Dr Meera Gupta: Yes. Unlike adults who are required to have a glomerular filtration rate of 20 or less in order to get listed, pediatric patients qualify for listing on the day of registration by the transplant center, regardless of clinical criteria or from the day they started dialysis. So it really is the impression of the committee and the pediatric transplant team, whether or not a child needs a transplant because every child is different. Their kidney diseases can be different. It can affect their overall health in different ways from actual renal function to development and growth. So there's a lot more flexibility in our ability to list a child for kidney transplantation.

Cheryl Martin: What else would you like our listeners to know?

Dr Meera Gupta: I think that pediatric kidney transplantation is a really great thing to have because kids in Kentucky and surrounding states who have subtle findings of kidney disease, or even end-stage kidney disease deserve to get transplanted if they need it. And I feel very lucky and fortunate that we're able to provide that and to provide good quality care to patients that come to UK Transplant.

Cheryl Martin: Thanks so much, doctor, for providing some key information for families who are on the transplant journey with their child. Dr. Meera Gupta is a surgical director of UK HealthCare's Pediatric Kidney Program. If you'd like more information, just visit our website, ukhealthcare.uky.edu. That's ukhealthcare.uky.edu.

This wraps up this edition of UK HealthCast from University of Kentucky Healthcare. If you found this information helpful, please share the link with a friend and subscribe to the podcast. Thanks so much for listening.