# Quality and Preparation of Pediatric Patients for Kidney Transplantation: Experience at Prince Sultan Military Medical City

## TL;DR

This paper describes a comprehensive protocol for preparing pediatric patients for kidney transplants at a Saudi hospital, emphasizing quality care and multidisciplinary teamwork.

## Contribution

The paper presents a structured, multidisciplinary protocol for pediatric kidney transplantation aligned with international standards and tailored to local healthcare policy.

## Key findings

- A multidisciplinary approach with weekly team meetings improves outcomes and early complication detection.
- Both living and deceased donor programs enhance access and equity in pediatric kidney transplantation.
- Formalized transition to adult care at age 14 supports long-term graft survival and patient well-being.

## Abstract

Background and objective

Kidney transplantation is the preferred treatment for children with end-stage kidney disease (ESKD), offering superior survival, quality of life, and growth outcomes compared with dialysis. Achieving successful outcomes requires thorough preparation and strict adherence to standardized protocols. This study aimed to report the quality measures and standardized preparation protocol for pediatric kidney transplantation at Prince Sultan Military Medical City (PSMMC), Riyadh, Saudi Arabia.

Methods

This manuscript describes the multidisciplinary protocol for pediatric transplant candidates and patients undergoing evaluation, including assessment of dialysis modality, pretransplant optimization, donor evaluation, immunological workup, perioperative management, and posttransplant care. Both hemodialysis and peritoneal dialysis are used as bridging modalities until transplantation. Kidney transplant types include deceased-donor kidney transplant, living-donor kidney transplant, living-related donor transplant, living-unrelated donor transplant, and preemptive kidney transplantation. At PSMMC, approximately 10-15 pediatric kidney transplants are performed annually.

Results

PSMMC implements a comprehensive, multidisciplinary approach to ensure quality and safety. This includes structured medical, nutritional, psychosocial, and immunological preparation; regular multidisciplinary team meetings; infection prophylaxis according to strict guidelines; and a clearly defined immunosuppression management plan. The availability of both living and deceased donor programs improves access and equity of care.

Conclusions

The pediatric kidney transplant program at PSMMC aligns with international quality assurance standards and national healthcare policy. Thorough pretransplant evaluation, close multidisciplinary collaboration, and weekly team meetings facilitate follow-up and early detection of complications. Benefits include improved nutrition and growth, consistent immunosuppression, robust infection prophylaxis, and long-term postoperative management. The inclusion of both living and deceased donor programs provides families with greater choice, shorter wait times, and a family-centered approach to psychosocial care, enhancing compliance and long-term graft survival. A formalized transition from pediatric to adult nephrology care, initiated at age 14, ensures continuity of care. This structured, phased protocol fosters autonomy in adolescents, supporting sustained transplant success. Collectively, these strategies enhance graft longevity, patient well-being, and a smooth transition from childhood to adulthood. Ongoing advancements in clinical protocols and transition models further establish PSMMC as a leading center for pediatric kidney transplantation in Saudi Arabia, recognized for exemplary patient-centered care and long-term outcomes.