When an adolescent girl presented with a history of urinary tract infections (UTIs) and abdominal pain, with sustained elevation in her creatinine, she was referred to Duke nephrology in March 2024, where she was diagnosed with renal dysplasia and vesicoureteral reflux nephropathy.
“Usually with recurrent UTIs, a patient would be referred to nephrology sooner,” says pediatric nephrologist Eileen Tsai Chambers, MD, medical director of Duke’s Pediatric Kidney Transplant Program. “But this patient came to us when she was already in late-stage chronic kidney disease.” By June, the 13-year-old was listed for transplant preemptively to try to prevent the need for dialysis.
“If you can avoid dialysis,” says Chambers, “it has been shown the kidney will last longer after transplant, prolonging the patient’s survival.”
How did Chambers and the Duke team find a kidney donor and avoid dialysis?
Although the patient’s mother was a good match for her, the transplant team hoped to find a younger kidney that was just as well matched. Through paired donor exchange, the patient’s mother donated her kidney, which was matched with a recipient through the National Kidney Registry (NKR). The patient then received a voucher for a living kidney donation.
When the registry found a better age match for the patient, she received a kidney transplant in January 2025, only 10 months after she began care at Duke, without requiring dialysis. “We were rapidly able to get her a kidney transplant,” says Chambers. “That speed is remarkable. She’s doing well now, with increased energy and improved quality of life.”
The NKR played a significant role in a timely transplant. Pediatric patients are given preference in the registry. With living donors, kidneys tend to last longer with more compatible matches, and surgeries can be scheduled to benefit patients.
“Not all centers work with NKR,” says Chambers. Duke offers many advantages for pediatric transplant patients. In addition to tailored care, the health system leads cutting-edge clinical trials, offers novel immunosuppression, and promotes preemptive pediatric transplant as illustrated by this patient. The pediatric team also partners with their adult counterparts to seamlessly transition the patient, providing continuous care as they age.
For patients with kidney dysfunction, timely referral to nephrology is vital. “Don’t delay referral,” says Chambers. “When creatinine is doubled, as with this patient, this should be an urgent referral.” Early referral to an advanced transplant center such as Duke gives patients more options, improving outcomes and access to lifesaving care.
