UH Rainbow Delivers Exceptional Outcomes for Pediatric Kidney Transplantation

Expert nephrology team offers early and preemptive transplantation

Innovations in Pediatric Nephrology | Special Issue October 2020

After three long and limiting years on dialysis, a 13-year-old girl was referred to the nephrology specialists at University Hospitals Rainbow Babies & Children’s Hospital. Within a month, she was listed for kidney transplant. By August, she had her new kidney.

Meelie DebRoy, MD

Her story highlights the Division of Pediatric Nephrology’s commitment to transplant children facing late-stage chronic kidney disease efficiently and safely. “Of all the age groups, pediatric patients have the highest survival benefit after transplantation,” says Meelie DebRoy, MD, Director of Pediatric Transplant Surgery at UH Rainbow Babies & Children’s Hospital and Associate Professor of Surgery at Case Western Reserve University School of Medicine. “National transplant governing organizations recognize this and prioritize allocation of organs for pediatric patients.”

UH Rainbow has excellent outcomes in both survival after kidney transplant and percentage of dialysis patients who receive transplants. Based on the report from the Scientific Registry of Transplant Recipients (SRTR), UH Rainbow has the best 1 year graft survival rates Northeastern Ohio for pediatrics.  Additionally, their impressive outcomes meet or exceed national averages.

Transplant team members are also proactive in offering preemptive transplantation to avoid the complications of dialysis and statistically improve both graft and patient survival. “It is always our goal for children never to need dialysis,” says Dr. DebRoy. “We strive to provide preemptive transplantation whenever possible because the superior outcomes as compared to dialysis in children have been reiterated many times over in the literature.”

Early transplantation is associated with mitigation of some significant complications of pediatric chronic kidney disease, including:

• Cognitive delay
• Cardiovascular disease
• Bone mineral regulation
• Inhibited growth
• Diminished quality of life
• Elevated rates of depression and anxiety
• Reduced overall lifespan

MULTIDISCIPLINARY CARE

As a result of a concerted, deliberate effort by University Hospitals leadership over the past two years, the pediatric nephrology program at UH Rainbow Babies & Children’s Hospital has recruited a dynamic team, including a new division chief and nephrology experts from around the country, to extend transformational care throughout Northeast Ohio and beyond.

“Any transplant, deceased or living, is better than remaining on dialysis for a child,” says Christina Nguyen, MD, Division Chief of Pediatric Nephrology at UH Rainbow Babies and Children's Hospital and Clinical Assistant Professor at the School of Medicine. “It can significantly add years in terms of graft and patient survivorship.”

The dedicated specialists combine their training with sophisticated technology and leading-edge research endeavors to ensure that patients as young as age one through age 22 receive the comprehensive renal and transplant care they need. “The success we have achieved has only been possible because we foster a truly multidisciplinary approach,” says Dr. DebRoy. “Our patients deserve the best care we can provide.”

Team members include:

• Nephrologists
• Transplant surgeons
• Urologists
• Transplant nurse coordinators
• Social workers and psychologists
• Dieticians
• Physical therapists

ROBUST LIVING DONOR PROGRAM

University Hospitals has an active living donor program, and transplant coordinators work tirelessly to ensure the safety of both the donor and recipient. Patients can be transplanted with kidneys from both living and deceased donors, although living donor transplantation offers superior outcomes in children.

Collaboration between pediatric and adult programs ensures that both donor and recipient are informed, screened and prepared for their procedures. University Hospitals also partners with the National Kidney Registry, enabling patients and their donors to exchange kidneys across a national network when the patient’s living donor is not compatible.

BRIDGE TO LIFELONG CARE

The average viability of a donor kidney is about 15 years, meaning that most patients who receive a kidney in childhood will need subsequent transplants. As a leading academic health care center, University Hospitals is well-positioned to transition patients from pediatric to adult specialists, providing a continuum of care throughout their lifetime. “The breadth and depth of our expert practitioners help bridge the pediatric and adult world,” says Dr. DebRoy. “The coordination of care is a testament to our diligence in ensuring our patients receive not only an expeditious transplant but also a chance to live full, meaningful lives.”

For more information or to refer a patient, call 216-553-1947, or email Dr. DebRoy at Meelie.DebRoy@UHhospitals.org.