Experience With Your Most Complex Transplant Candidates

Complex urologic disease. Multisystem complications. Patients who are very small. These are the transplant candidates the Kidney Transplant Program at Cincinnati Children's sees most often.

"Over the past five years, kidney transplant candidates at Cincinnati Children's have become more medically complex," says Charles Varnell Jr., MD, MS, medical director of the Kidney Transplant Program. "But despite that, we're maintaining clinical outcomes we're really proud of."[

That experience matters for your patient. Cincinnati Children's surgeons have performed pediatric kidney transplants for more than 60 years, and the program completed nearly 40 transplants in the past year alone. That makes it one of the highest-volume pediatric programs in the U.S. If your patient's case feels unusual, chances are this team has managed one like it.

Your patient also benefits from what other centers learn. Cincinnati Children's leads the Improving Renal Outcomes Collaborative (IROC), a national learning health network where pediatric kidney transplant centers share data to improve outcomes—particularly by reducing rejection. Strategies that work across the network inform care here.

You Stay Involved—Before, During and After Transplant

Referring a patient for transplant doesn't mean handing them off for good. Cincinnati Children's serves as the primary kidney transplant center for several hospitals in the region, and each partnership is designed to keep the referring team connected.

• We manage the transplant journey. The transplant team handles pre-transplant evaluation, organ offers, the transplant procedure and early postoperative care.
• Your patient comes back to you. Depending on the partnership, patients return to their referring center at discharge or one year after transplant.
• You have a standing line to the team. Monthly meetings with referring providers review patients transplanted within the past three years. You can also bring cases for a second opinion.
• Complications have a clear path. Any patient who develops complications can return to Cincinnati Children's for follow-up care.

[Disruption Box] Referring a Patient for Kidney Transplant

To refer a patient for kidney transplant:

• Call 513-636-4531
• Fax a referral form to 513-636-7407
• Refer online

A pre-transplant coordinator will gather records and schedule consultations, imaging and labs over a one- or two-day period.

Multidisciplinary Planning for Medically Complex Patients

If your patient's needs extend beyond the kidney, the specialists they need are already part of the transplant plan. Complex urologic disease is the most common reason for referral, and many patients also have multisystem complications such as cancer, need for bone marrow transplant or anorectal malformation. Transplant nephrologists routinely work with:

• Allergy and immunology
• Cardiology, including heart failure and heart transplant specialists
• Colorectal surgery
• Gynecology
• Infectious diseases specialists focused on immunocompromised patients
• Neurology
• Oncology
• Pulmonology
• Urology and transplant surgery

Problems get raised early, before they affect the transplant. The team reviews pre- and post-transplant patients weekly with every provider involved in a patient's care and holds larger monthly meetings with surgery and urology.

“The real strength of our program comes from having multiple experts in the room to do surgical planning and troubleshooting,” says Timothy Caldwell, MD, PhD, a transplant nephrologist in the program. “The expectation is communication. We discuss any potential problems a patient may have ahead of time.”

For babies born without kidney function, there's a path to transplant from the first week of life. Working with fetal care colleagues, the team provides neonatal dialysis with the Carpediem™ machine. Many of these patients stay on dialysis for about two years as they prepare for transplant.

A Streamlined, Thorough Pre-Transplant Evaluation

After referral, your patient's evaluation is scheduled over one or two days, so families make fewer trips.

“Most patients haven’t spent their whole healthcare journey with us,” says Dr. Caldwell. “We want to make sure we don’t miss anything—small or large—that may be hiding in their health history. So, we’re exceptionally thorough as we guide them through their transplant journey.”

Research Aimed at the Problems You See in Clinic

Under the leadership of Michael Seifert, MD, MSCI, director of the Division of Nephrology and Hypertension, Cincinnati Children’s is one of roughly 20 sites nationwide participating in the CTOT-41 trial. This study is designed to test a novel immunosuppression regimen, already approved for use in adults, to determine its safety and efficacy in children.

Additional research includes:

• Rejection you can see coming: urinary protein biomarkers that may predict rejection
• Rejection that behaves differently: how rejection after stopping immunosuppression differs from rejection during illness
• Adolescents who stop taking their medications: work with clinical psychologists on adherence, a key driver of late rejection and graft loss

“We are not researchers who happen to take care of patients,” Dr. Caldwell says. “We are people who take care of patients and want to do research to take better care of them.”

To refer a patient, place a referral through Epic, call 513-636-4531 or fax a referral form to 513-636-7407. Learn more about the Kidney Transplant Program at Cincinnati Children’s.

(Published October 2026)

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