Acute Management of the Post-operative Renal Transplant

Today’s episode is dedicated to post-operative management in the PICU of the pediatric renal transplant patient. Join us as we discuss the patient case, symptoms, and treatment. 

 Joining the conversation is Dr. Rouba Garro, Associate Professor of Pediatrics at Emory University School of Medicine and the Medical Director of the Kidney Transplant Program at Children’s Healthcare of Atlanta. Children’s Healthcare of Atlanta has one of the largest kidney transplant programs in the country and is the largest in the Southeast US with excellent patient and graft survival. 

Show Highlights: 

• Our case, symptoms, and diagnosis: a five-year-old is transferred to the PICU after a related living kidney transplant for end-stage renal disease due to obstructive uropathy. The patient has a history of post-urethral valves and is on room air, IV fluids, an arterial line, and a Foley catheter is in place.
• The top indicators for renal transplant in pediatrics vary according to age, but congenital anomalies are the most common in children younger than six.
• The criteria for being considered for kidney transplantation include several factors, including when kidney function drops below 20%.
• The keys for successful transplantation:
• An experienced pre-transplant team
• A robust and experienced team for perioperative care and graft outcome
• A comprehensive and multidisciplinary post-transplant team
• The process of organ procurement for cadaveric and living donor renal transplants includes the following:
• Multiple factors determine the points a patient receives toward transplant priority
• Deceased donor kidneys are classified using the KDPI (kidney donor profile index)
• A thorough evaluation is performed for living donors
• Advantages to living donation include a shorter time on dialysis and waitlists, improved graft survival, and shorter ischemia time than from a deceased donor
• Information from the operating team that is vital for the PICU team to know for post-op success includes patient history, transplant details, ischemia time, and transplant complications.
• Red flags for the critical care post-op team are in the three categories of blood pressure, urine output, and kidney function/electrolytes. 
• The need to watch for signs of infection in the post-op phase
• How immunosuppressive medications might be used for the pediatric renal transplant patient
• Why the post-op transplant patient might need dialysis
• Clinical pearls for post-op care of the pediatric renal transplant patient in the PICU:
• Teamwork and collaboration are key elements for success.
• The most important task is to monitor blood pressure, urine output, and electrolytes.