Kidney transplantation

Kidney transplantation is the treatment of choice for end-stage renal disease (ESRD) in children. Although long-term survival on dialysis has improved over the past three decades, survival remains better for children who undergo kidney transplantation. Children undergoing kidney transplantation frequently require post-operative care in the Pediatric Intensive Care Unit (PICU). For example, it is frequently necessary to infuse large volumes of fluid, plasma, and blood to prevent hypovolemia, acute tubular necrosis, and venous thrombosis of the renal allograft. These problems are compounded when a relatively young child receives an adult allograft. Because a large volume of blood is shifted to the renal allograft, the recipient's heart will have to work harder to circulate a relatively higher cardiac output (CO) to the adult-sized renal allograft. Post-operative fluid management and hemodynamic monitoring is therefore of crucial importance. Finally, there are several potential complications in the early and late post-operative period that are relevant to the pediatric critical care physician.