Intensive Care of the Child After Kidney Transplantation

  • Alan Salas
  • Nicholas Slamon
Reference work entry
Part of the Organ and Tissue Transplantation book series (OTT)


A multidisciplinary team including pediatric transplant surgeons or urologists, pediatric nephrologists, and specialized nurses is needed to provide optimal care after a renal transplant. Perioperative clinical and surgical complications requiring particularly close follow-up include fluid and electrolyte management, blood pressure control, and graft function surveillance. Timely imaging is required in the first postoperative day, using Doppler ultrasound to evaluate for compromised graft blood flow. Immunosuppressive therapy is key to graft survival and is optimized in the initial perioperative period.


Kidney Renal Transplantation Critical Care Intensive Care Postoperative Immunosuppression Hypertension 


  1. Bakr MA, Denewar AA, Abbas MH (2016) Challenges for Renal Retransplant: an overview. Exp Clin Transplant 14(Suppl 3):21–26PubMedGoogle Scholar
  2. Brunkhorst LC, Fichtner A, Höcker B, Burmeister G, Ahlenstiel-Grunow T, Krupka K et al (2015) Efficacy and safety of an Everolimus- vs. a mycophenolate Mofetil-based regimen in pediatric renal transplant recipients. PLoS One 10(9):e0135439CrossRefPubMedCentralPubMedGoogle Scholar
  3. Cameron C, Vavilis G, Kowalski J et al (2014) An observational cohort study of the effect of hypertension on the loss of renal function in paediatric kidney recipients. Am J Hypertens 27:579–585CrossRefPubMedGoogle Scholar
  4. Cameron BM, Kennedy SE, Rawlinson WD, Mackie FE (2016) The efficacy of valganciclovir for prevention of infections with cytomegalovirus and Epstein-Barr virus after kidney transplant in children. Pediatr Transplant 21:1–11Google Scholar
  5. Campos L, Parada B, Furriel F, Castelo D, Moreira P, Mota A (2012) Do intraoperative hemodynamic factors of the recipient influence renal graft function? Transplant Proc 44(6):1800–1803CrossRefPubMedGoogle Scholar
  6. Dharnidharka VR, Fiorina P, Harmon W (2014) Kidney transplantation in children. N Engl J Med 371:549–558CrossRefPubMedGoogle Scholar
  7. Drake K, Nehus E, Goebel J (2015) Hyponatremia, hypo-osmolality, and seizures in children early post-kidney transplant. Pediatr Transplant 19:698–703. CrossRefPubMedGoogle Scholar
  8. Faguer S, Kamar N, Guilbeaud-Frugier C et al (2007) Rituximab therapy for acute humoral rejection after kidney transplantation. Transplantation 83:1277–1280CrossRefPubMedGoogle Scholar
  9. Ghirardo G, De Franceschi M, Vidal E et al (2014) Transplant renal artery stenosis in children: risk factors and outcome after endovascular treatment. Pediatr Nephrol 29:461CrossRefPubMedGoogle Scholar
  10. Ghosh PS, Kwon C, Klein M, Corder J, Ghosh D (2014) Neurologic complications following pediatric renal transplantation. J Child Neurol 29(6):793–798CrossRefPubMedGoogle Scholar
  11. Giussani A, Ardissino G, Belingheri M, Dilena R, Raiteri M, Pasciucco A, Colico C, Beretta C (2016) Posterior reversible encephalopathy syndrome after kidney transplantation in pediatric recipients: two cases. Pediatr Transplant 20:68–71CrossRefPubMedGoogle Scholar
  12. Grenda R (2015) Biologics in renal transplantation. Pediatr Nephrol 30:1087CrossRefPubMedGoogle Scholar
  13. Gulhan B, Topaloglu R, Karabulut E et al (2014) Post-transplant hypertension in paediatric kidney transplant recipients. Pediatr Nephrol 29:1075–1080CrossRefPubMedGoogle Scholar
  14. Guzzo I, Morolli F, Camassei FD et al (2017) Acute kidney transplant rejection mediated by angiotensin II type 1 receptor antibodies in a pediatric hyperimmune patient. Pediatr Nephrol 32:185CrossRefPubMedGoogle Scholar
  15. Haas M (2014) An updated Banff schema for diagnosis of antibody mediated rejection in renal allografts. Curr Opin Organ Transplant 19(3):315–322CrossRefPubMedGoogle Scholar
  16. Hamdani G, Nehus EJ, Hooper DK, Mitsnefes MM (2016) Masked hypertension and allograft function in pediatric and young adults kidney transplant recipients. Pediatr Transplant 20:1026–1031CrossRefPubMedGoogle Scholar
  17. Hocker B, Zencke S, Krupka K, Fichtner A, Pape L, Dello Strologo L, Guzzo I, Topaloglu R, Kranz B, Konig J, Bald M, Webb NJA, Noyan A, Dursun H, Marks S, Yalcinkaya F, Thiel F, Billing H, Pohl M, Fehrenbach H, Bruckner T, Tonshoff B (2016) Cytomegalovirus infection in pediatric renal transplantation and the impact of chemoprophylaxis with (Val-)ganciclovir. Transplantation 100(4):862–870CrossRefPubMedGoogle Scholar
  18. Hoorn EJ (2016) Intravenous fluids: balancing solutions. J Nephrol 30:485. [Epub ahead of print]CrossRefPubMedCentralPubMedGoogle Scholar
  19. Jordan CL, Taber DJ, Kyle MO, Connelly J, Pilch NW, Fleming J, Meadows HB, Bratton CF, Nadig SN, McGillicuddy JW, Chavin KD, Baliga PK, Shatat IF, Twombley K (2016) Incidence, risk factors, and outcomes of opportunistic infections in pediatric renal transplant recipients. Pediatr Transplant 20:44–48CrossRefPubMedGoogle Scholar
  20. Kim IK, Choi J, Vo AA, Kang A, Patel M, Toyoda M, Mirocha J, Kamil ES, Louis Cohen J, Louie S, Galera O, Jordan SC, Puliyanda DP (2016) Safety and efficacy of Alemtuzumab induction in highly sensitized pediatric renal transplant recipients. Transplantation 101:883. Publish Ahead of PrintCrossRefGoogle Scholar
  21. Kim MU, Kim SY, Park YH. A case of tacrolimus-induced encephalopathy after kidney transplantation. Korean J Pediatr 2011;54(1):40–45Google Scholar
  22. Koshy SM, Guttmann A, Hebert D et al (2009) Incidence and risk factors for cardiovascular events and death in paediatric renal transplant patients: a single centre long-term outcome study. Pediatr Transplant 13:1027–1033CrossRefPubMedGoogle Scholar
  23. Lim WH, McDonald SP, Kennedy SE, Larkins N, Wong G (2016) Association between slow and delayed graft function with graft outcomes in Paediatric and adolescent deceased donor kidney transplant recipients. Transplantation 101:1906CrossRefGoogle Scholar
  24. McCoy H (2008) Posterior reversible encephalopathy syndrome: an emerging clinical entity in adult, pediatric, and obstetric critical care. J Am Acad Nurse Pract 20(2):100–106CrossRefGoogle Scholar
  25. Mitsnefes MM, Khoury PR, McEnery PT (2003) Early posttransplantation hypertension and poor long-term renal allograft survival in paediatric patients. J Pediatr 143:98–103CrossRefPubMedGoogle Scholar
  26. Mueller T (2007) Mechanisms of action of thymoglobulin. Transplantation 84(11):S5–S10CrossRefGoogle Scholar
  27. Ng YW, Singh M, Sarwal MM (2015) Antibody-mediated rejection in pediatric kidney transplantation: pathophysiology, diagnosis, and management. Drugs 75:455CrossRefPubMedGoogle Scholar
  28. Opelz G, Dohler B (2005) Improved long-term outcomes after renal transplantation associated with blood pressure control. Am J Transplant 5:2725–2731CrossRefPubMedGoogle Scholar
  29. Peruzzi L, Amore A, Coppo R (2014) Challenges in pediatric renal transplantation. World J Transplant 4(4):222–228CrossRefPubMedCentralPubMedGoogle Scholar
  30. Pirojsakul K, Desai D, Lacelle C et al (2016) Management of sensitized pediatric patients prior to renal transplantation. Pediatr Nephrol 31:1691CrossRefPubMedGoogle Scholar
  31. Santoveña AZ, Meseguer CG, Mejia SM, Melgar AA, Camblor CF, Hijosa MM, Carrion AP, Roman LE. BK Virus Infection in Pediatric Renal Transplantation. Transplant Proc. 2015 Jan-Feb;47(1):62–6Google Scholar
  32. Sautenet B, Blancho G, Büchler M et al (2015) One-year results of the effects of rituximab on acute antibody-mediated rejection in renal transplantation: RITUX ERAH, a multicenter double-blind randomized placebo-controlled trial. Transplantation 100:391–399CrossRefGoogle Scholar
  33. Seeman T (2009) Hypertension after renal transplantation. Pediatr Nephrol 24:959–972CrossRefPubMedGoogle Scholar
  34. Sierralta MC, González G, Nome C, Pinilla C, Correa R, Mansilla J, Rodríguez J, Delucchi A, Ossandón F (2015) Kidney transplant in pediatric patients with severe bladder pathology. Pediatr Transplant 19:675–683CrossRefPubMedGoogle Scholar
  35. Smith JM (2015) Viral surveillance and subclinical viral infection in pediatric kidney transplantation. Pediatr Nephrol 30:741Google Scholar
  36. Sollinger H et al (2001) Basiliximab versus antithymocyte globulin for prevention of acute renal allograft rejection. Transplantation 72(12):1915–1919CrossRefPubMedGoogle Scholar
  37. Tai-Heng Chen MD, Wei-Chen Lin MD, Yong-Hao Tseng MD, Chien-Ming Tseng MD, Tai-Tsung Chang MD, Tzeng-Jih Lin MD (2013) Posterior reversible encephalopathy syndrome in children. J Child Neurol 28(11):1378–1386CrossRefPubMedGoogle Scholar
  38. Taylor K, Kim WT, Maharramova M, Figueroa V, Ramesh S, Lorenzo A (2016) Intraoperative management and early postoperative outcomes of pediatric renal transplants. Paediatr Anaesth 26:987–991CrossRefPubMedGoogle Scholar
  39. Torricelli FCM, Watanabe A, David-Neto E, Nahas WC (2014) Current management issues of immediate postoperative care in pediatric kidney transplantation. Clinics 69(Suppl 1):39–41CrossRefPubMedCentralPubMedGoogle Scholar
  40. Trachtman H, Frymoyer A, Lewandowski A, Greenbaum L, Feig D, Gipson D, Warady B, Goebel J, Schwartz G, Lewis K, Anand R, Patel U, on behalf of the Best Pharmaceuticals for Children Act–Pediatric Trials Network Administrative Core Committee (2015) Pharmacokinetics, pharmacodynamics, and safety of Lisinopril in pediatric kidney transplant patients: implications for starting dose selection. Clin Pharmacol Ther 98:25–33CrossRefPubMedCentralPubMedGoogle Scholar
  41. Varela-Fascinetto G, Benchimol C, Reyes-Acevedo R, Genevray M, Bradley D, Ives J, Silva HT Jr (2016) Tolerability of up to 200 days of prophylaxis with valganciclovir oral solution and/or film-coated tablets in pediatric kidney transplant recipients at risk of cytomegalovirus disease. Pediatr Transplant 21:1–11Google Scholar
  42. Verghese PS (2016) Pediatric kidney transplantation: a historical review. Pediatr Res 81:259CrossRefPubMedGoogle Scholar
  43. Weber LT (2015) Therapeutic drug monitoring in pediatric renal transplantation. Pediatr Nephrol 30:253CrossRefPubMedGoogle Scholar
  44. Weir MR, Burgess ED et al (2015) Assessment and Management of Hypertension in Transplant Patients. JASN 26:1248–1260. Epub ahead of printCrossRefPubMedCentralPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Nemours Alfred I. duPont Hospital for ChildrenWilmingtonUSA
  2. 2.Pediatric Critical Care MedicineNYU Langone Medical CenterNew YorkUSA

Section editors and affiliations

  • Tetsu Uejima
    • 1
  1. 1.Nemours/Alfred I. duPont Hospital for ChildrenWilmingtonUSA

Personalised recommendations