As the goal of kidney transplantation in a child/kid is to replace the diseased kidney with a healthy kidney from a living or deceased donor, allowing the child to regain normal kidney function, its procedure involves multiple stages, including pre-surgery preparation, the surgical procedure, and post-transplant care.

Pre-Transplant Preparation:

Before kidney transplantation, the child passes through the following stages under the affectionate supervision of experienced senior doctors: -

General Anesthesia - The child is given general anesthesia to keep them unconscious and pain-free during the procedure.
Central/Arterial Line Placement - The anesthesia team may insert a central or arterial line to monitor the child's blood pressure and fluid levels.
Foley Catheter Insertion - A Foley catheter is placed to drain urine from the bladder and protect the sutures where the ureter connects to the bladder.
Catheter Removal - The Foley catheter is typically removed within three days after the surgery.
Stability Monitoring - Continuous monitoring ensures the child's stability during the transplant.

The Surgical Procedure:

The following are the surgical measures:-

Incision - A small incision is made in the lower abdomen of the child.
Kidney Placement - The new kidney is placed in the lower abdomen without removing the non-functioning kidneys (unless necessary).
Vessel Connection - The new kidney's blood vessels (renal artery and vein) are connected to the child's existing blood supply.
Ureter Attachment - The ureter (urine tube) of the new kidney is attached to the bladder.
JP Drain Placement - A Jackson-Pratt (JP) drain may be placed to monitor internal bleeding or fluid leakage.
Drain Removal - The JP drain is typically removed within a few days once no complications arise.

Closing the Incision

Once the new kidney is in place and functioning, the surgical team carefully closes the incision with sutures. The child is then transferred to the Pediatric Intensive Care Unit (PICU) for close monitoring.

Post-transplantation Care:

Transfer to PICU (Pediatric Intensive Care Unit)

After the surgery, the child is taken to the PICU (Pediatric Intensive Care Unit) where nurses and doctors closely monitor their condition. An ultrasound of the new kidney is performed immediately after the transplant to ensure proper blood flow and kidney function. The child’s urine output is measured every hour to monitor the new kidney’s performance.

Fluid Monitoring and Puffy Appearance

In the first 24 hours, the child will receive large volumes of IV fluids to ensure that the new kidney stays hydrated and functional. This may cause the child to appear puffy or swollen, which is completely normal and temporary. It will subside as the body adjusts to the new kidney.

Ventilator and Dialysis Support (If required)

In some cases, the child may require temporary ventilator support post-surgery, especially if there were any complications during the procedure. In rare cases, hemodialysis may also be necessary to support kidney function until the new kidney fully takes over. Both measures are temporary and usually discontinued within a few days.

Eating and Drinking After Surgery

The child will usually be allowed to drink fluids within 24 hours after surgery. By the next day, solid food may also be introduced gradually, depending on the recovery progress.

Catheter Drain Removal

The Foley catheter, which was inserted before the surgery, is generally removed after 3 days once the doctors are confident that the new kidney is functioning properly.
The JP drain, placed to monitor internal bleeding or fluid leakage, is usually removed after a few days as well.

Pain Management Medications

After the surgery, the child may experience mild pain or discomfort around the incision site. The medical team administers pain relievers to manage any discomfort. Additionally, the child is immediately started on immunosuppressive medications to prevent the body from rejecting the new kidney.