Kidney transplant: Postoperative care and management of complications

Abstract

End-stage renal disease (ESRD) in India affects 151–160 individuals per million annually, with children contributing 1%–2%. Kidney transplantation is the optimal therapy for paediatric ESRD, offering superior survival, growth, and quality of life compared to dialysis. Congenital anomalies of kidney and urinary tract account for 50%–60% of paediatric chronic kidney disease, with transplantation indicated when glomerular filtration rate (GFR) falls below 15 mL/min/1.73 m ² . Pretransplant evaluation requires multidisciplinary assessment, including recipient history, donor selection, immunological risk stratification, and urological evaluation. Living donor transplantation is preferred, enabling preemptive opportunities and better graft survival. Immunosuppression is risk-stratified: Basiliximab for low-risk, anti-thymocyte globulin for higher risk, with calcineurin inhibitors and mycophenolate initiated preoperatively. Methylprednisolone is given intraoperatively and switched to oral steroids by day 4–5. Unique pediatric challenges include vascular steal and size mismatch, requiring aggressive fluid and blood pressure management. Postoperative care emphasizes fluid replacement, hemodynamic optimization, and infection prevention, with most children resuming normal life within 6–12 months.