Kidney transplantation in children

Your progress

Saved on this device.

Target exams

Red flags

• Sudden oliguria and a swollen tender graft in the early post-operative period suggesting renal vessel thrombosis and imminent graft loss
• A rising creatinine in a transplanted child that may represent acute rejection, calcineurin inhibitor toxicity, obstruction or recurrence of original disease
• Early and massive proteinuria within hours of transplant suggesting recurrence of focal segmental glomerulosclerosis requiring urgent plasmapheresis
• Fever with a rising EBV viral load in an EBV-mismatched recipient suggesting evolving post-transplant lymphoproliferative disorder
• Rising creatinine with a high BK virus load suggesting BK nephropathy that mimics acute rejection
• An adolescent with erratic tacrolimus levels, missed clinic visits and graft dysfunction suggesting non-adherence as the cause of late rejection
• Severe hypovolaemia or hypotension in the early post-operative period precipitating delayed graft function and acute tubular necrosis

Life stages

Care settings

Clinical exam formats

Board mappings

• Recognises kidney transplantation as the treatment of choice for end-stage kidney disease in children and outlines donor source and timing classification
• Identifies the standard maintenance immunosuppression regimen and the need for lifelong follow-up
• Refers children with advanced chronic kidney disease to a transplant centre early and considers preemptive living-donor transplant
• Justifies the choice of induction and maintenance immunosuppression based on immunological risk and explains calcineurin inhibitor pharmacology and monitoring
• Distinguishes T-cell-mediated from antibody-mediated rejection and manages each appropriately, including recurrent disease and BK nephropathy
• Leads adolescent transition, manages non-adherence, and addresses the long-term complications of chronic immunosuppression including PTLD and post-transplant diabetes
• Classification of kidney transplantation by donor source and timing, preemptive versus dialysis-first
• Standard maintenance immunosuppression and the role of therapeutic drug monitoring
• Causes of graft dysfunction in a transplanted child and the principles of investigation
• Assesses and investigates a rising creatinine in a paediatric kidney transplant recipient
• Counsels a family on living-donor versus deceased-donor transplant and the benefits of preemptive transplantation
• Manages an adolescent transplant recipient with suspected non-adherence and graft dysfunction
• Level 1: Recognises kidney transplant as the preferred treatment for end-stage kidney disease in children
• Level 2: Outlines immunosuppression principles and the common early complications of transplantation
• Level 3: Manages graft dysfunction, rejection and long-term complications, and leads transition to adult care
• Indications for kidney transplantation in children and the leading causes of paediatric end-stage kidney disease
• Classification into living versus deceased donor and preemptive versus dialysis-first
• The standard immunosuppression regimen and the timeline of post-transplant infections including PTLD
• Assessment and investigation of graft dysfunction in a child after kidney transplant
• Interpretation of a creatinine rise with tacrolimus trough and donor-specific antibody results
• Structured explanation of induction, maintenance immunosuppression and rejection treatment
• Recognition of kidney transplantation as optimal renal replacement therapy for children with end-stage kidney disease
• Principles of induction and maintenance immunosuppression including tacrolimus therapeutic monitoring
• Diagnosis and management of acute rejection, infection and post-transplant lymphoproliferative disorder
• Recognises the indications for and benefits of paediatric kidney transplantation
• Initiates appropriate workup and referral for transplant including vaccination and tissue typing
• Identifies graft dysfunction and the common complications of chronic immunosuppression
• Canadian approach to paediatric kidney transplant candidate selection and donor source
• Immunosuppression protocols and the management of rejection and opportunistic infection
• Long-term surveillance, growth, transition and graft-loss prevention strategies