Pediatric Kidney Transplant on Complex Abdomens and After Intestinal Transplant

Since 2001, the kidney transplant program at UPMC Children’s Hospital of Pittsburgh has completed 16 pediatric kidney transplants in patients that have received previous intestinal transplant. These patients have undergone an intestinal transplant after developed intestinal failure either when they lost their intestine, if the intestine was not able to absorb nutrition, or provide enough fluids to maintain a normal life. Subsequently, they progressed to renal failure and were considered for kidney transplant.

Complex Abdomen Definitions

One aspect of a complex abdomen is the loss of the abdominal domain or abdominal volume. For example, if a patient has undergone multiple previous surgeries that created a lot of scar tissue, this then causes the loss of the abdominal wall or abdominal muscle, and the abdominal cavity will contract. Because of this, it can be very difficult to access the abdomen for a kidney transplant without injuring other organs.

Another aspect of a complex abdomen is related to the vasculature where the new kidney will be placed. Patients that have been on prolonged nutritional support through the central veins can lose that access. This also means that those veins and arteries that are used for the kidney are injured so we have less vascular access to place the new kidney.

For a child of about 20 lbs., the abdominal cavity is very small. However, the kidneys that we use in a living donor transplant must be donated from full-size adults ages 18 and older. An adult kidney is about 12 centimeters, which can be difficult to place in the abdomen of a child. However, we have a very skilled team that can handle these types of anatomic variants and complex vasculatures.

Transplant Qualifications

Any patient that develops stage five chronic kidney disease, end-stage renal disease, or requires dialysis with a GFR of less than 20% can qualify for a kidney transplant. It is best to have a living donor for this surgery, since with complex abdomens with poor vascular access, it is ideal to have a scheduled surgery. When this happens, we can admit the patient in the day before, dialyze them if needed, and start the recipient operation to make sure we can enter the abdomen safely and secure proper vascular access. At this point, we will proceed safely with the donor’s kidney retrieval. It’s very convenient when there is a living donor and it is strongly recommended, but we also understand that not everybody has access to living donation. UPMC encourages and utilizes living donors whenever possible.

Why Patients Choose UPMC

We have received referrals from around the country for this type of transplant. What differentiates UPMC from other centers is the fact that we have experience in both multivisceral and intestinal transplant, as well as living-donor kidney transplantation. We also have a kidney donor paired exchange program so we can match patients with the most compatible donor. 

Length of Surgery

The time it takes to complete this surgery depends on the complexity of the abdomen. To access the abdomen, it can be between one to two hours, and with the kidney transplant itself, another two hours. Surgery can be between four to six hours if the abdomen is not difficult to access.

Quality of Life After Transplant

This surgery typically greatly improves a patient’s quality of life. Patients that develop chronic kidney disease and end-stage renal disease will eventually need to be on hemodialysis if they do not undergo a kidney transplant. Hemodialysis is a process of purifying the blood of a person whose kidneys are not functioning properly through a dialysis machine for three to four hours every other day. The complications of hemodialysis are also higher compared to a kidney transplant. Acute complications on hemodialysis can include cardiovascular issues and hypotension.

Outcomes After Surgery

Patients can reduce their risk of complications after surgery by taking their medications correctly and following their physician’s recommendations. For pediatric patients especially, family and a support system are fundamental and vital. At UPMC, we consider family as part of our team.

This surgery, in our experience, has a 100% patient survival rate after five years and there is more than 95% graft survival, or organ survival, at three and even five years, which is the same as a pediatric kidney transplant on a non-complex abdomen. Increased survival rates depend on how early the patient has been referred to UPMC Children’s for a kidney transplant.

For more information about our program and how to begin the referral process, call 412-692-5182.