Question

Outline strategies that address the psychological impact of renal transplant on the child and family. Identify educational resources for patients and their families.

Answer 1

Kidney transplant is the preferred treatment for kidney failure for most children. A kidney transplant gives a child the best opportunity to lead a normal and healthy life. However, a transplant is not a cure and comes with many new responsibilities. Most children with kidney failure are referred by their doctor to a center with a pediatric kidney transplant program. Most children are eligible for kidney transplants. Some children are not candidates because of medical and ethical reasons.

Renal transplantation is accepted as the treatment choice for children with end stage renal disease, as it provides better quality of life and improves long-term survival than other types of renal replacement therapies. Children require prolonged therapy with immunosuppressive drugs after transplantation and the short and long-term adverse effects associated with these agents remain a challenge for clinicians. Complicating this issue is the fact that children often require prescriptions for various clinical conditions and it becomes crucial for pediatricians to be informed about potential drug interactions when prescribing additional medications.

The causes of chronic kidney disease in childhood are varied. Children will qualify for transplants when their kidney function falls below 20 mL/min/1.73m2. Generally, any child who requires dialysis is a candidate for kidney transplantation. Examples of medical reasons that might prevent a child from being a good candidate for kidney transplantation include severe heart or lung disease, active or recent cancer (malignancy), or certain active infections and certain ethical considerations.

After the consultations and tests, the whole transplant team meets to decide if the child is a suitable candidate for a kidney transplant. The team approach to care makes sure that every treatment option for the child’s case will be discussed. If the transplant is the best option, the team will then decide how quickly the child needs it and whether the child should receive a transplant from a living donor or be placed on the kidney transplant waiting list. The team will develop a treatment plan designed to give the child the best chance of having a successful transplant. If the child is able, it is important that they, along with you, take part in making decisions about their treatment. Receiving and living with a transplant is a big commitment, one that will stay with your child for the rest of their life. Only if the transplant team agrees that transplant is the best option for the child and the family agree that they want their child to have a transplant, will the child go to transplant. If the child is being assessed for emotional support and therapy, they will be seen alone (if they are old enough) and with family. Depending on the child’s age, they or family will be asked about how they have been feeling and about their mood, relationships, participation in school, social and recreational activities, sleep, appetite, and any other worries or changes in their life.

The psychologist may also ask the child, family, or the child’s teachers to fill out some questionnaires to get an idea of how everyone thinks the child is doing. Sometimes, the psychologist may diagnose a specific mental health difficulty such as depression or anxiety. It may then be helpful for the child to see a psychologist or mental health therapist (such as a counselor) for a number of sessions. They can listen to the child, help them understand why they feel this way, and give some ideas about things the child can do, or say, to help change the way they feel. They may also discuss these ideas with the family or with other important people in your child’s life (such as their teacher) so that everyone understands and can work together to help the child. In some instances, medication might be recommended for older children, who may also need to see a psychiatrist or adolescent medicine doctor for an evaluation and monitoring.

Exercise and physical activities are part of a kidney healthy lifestyle and we encourage regular activity in all transplant patients. Regular exercise is a crucial part of keeping the child strong and healthy. It helps them develop socially, it develops their motor skills (such as hand-eye-coordination and movement), and it boosts their overall level of fitness. The family is encouraged to enroll the younger child in developmental playgroups and community activities. Older children can take part in recreational and organized sports and join school or community teams. Encourage the child to try new activities – that way, they can find things that they really enjoy doing and will stick with them.