Dr Ware is a consultant paediatric nephrologist at Evelina London Children’s Hospital. He has expertise in all aspects of children’s renal medicine. Alongside his colleague Dr Helen Jones, he leads the Evelina London transplant service, one of the largest and busiest children’s kidney transplant units in the UK.
For parents, hearing that their child has kidney failure is overwhelming. Families are suddenly introduced to a world of dialysis, complex medications, hospital appointments and uncertainty about the future. Many children are diagnosed very young, often with congenital abnormalities or rare genetic conditions that can eventually lead to chronic kidney disease and, in some cases, kidney failure.
As paediatric specialists, one of our responsibilities is helping families navigate that journey while also ensuring children can continue to live as normal a childhood as possible. For this reason, kidney transplantation remains a transformative treatment for children with severe kidney disease.
A successful transplant does far more than replace kidney function. It can give children the opportunity to return to school regularly, spend more time with friends, take part in activities they enjoy and regain a sense of independence that prolonged illness often takes away. For many families, transplantation represents the moment life begins to feel hopeful again.
Specialist services
At Evelina London, we care for children with a wide range of kidney conditions, including congenital abnormalities, nephrotic syndrome, recurrent urinary tract infections, glomerulonephritis and complex syndromes affecting renal development. Some children develop kidney failure very early in life, while others experience gradual deterioration over many years.
Paediatric kidney care is particularly complex because children are still growing and developing. Treatment, therefore, has to consider far more than the kidneys alone. Kidney disease can affect growth, nutrition, emotional wellbeing and educational development, requiring close collaboration between multiple specialist teams.
As a multidisciplinary children’s hospital, Evelina London brings together expertise across paediatric nephrology, surgery, radiology, intensive care and transplantation. This joined-up model is especially important in complex transplant cases, where successful outcomes depend on detailed coordination between specialists before, during and after surgery.
My own work focuses on all aspects of children’s kidney medicine, alongside leading the Evelina London transplant service with my colleague Dr Helen Jones. Together with our wider team, we undertake one of the largest and busiest paediatric kidney transplant programmes in the UK, caring for children referred both nationally and internationally.
Improving children’s lives through innovation
One of the most important advances in paediatric kidney transplantation has been the move towards pre-emptive transplantation wherever possible. Traditionally, many patients would spend prolonged periods on dialysis before receiving a transplant. While dialysis is life-saving, it can also place a significant physical and emotional burden on children and families.
Pre-emptive transplantation aims to perform the transplant before dialysis becomes necessary. For suitable patients, this approach can improve long-term outcomes and reduce some of the disruption associated with ongoing dialysis treatment. Importantly, it also allows children to spend more time at home, in school and with their families rather than in hospital settings.
Living donor transplantation plays a major role in making this possible. At Evelina London we are proud to deliver one of the largest and most successful living donor transplantation programmes in Europe. When a suitable donor is available, often a relative, surgery can be planned in a more controlled and timely way, improving the overall experience for families.
Innovation has also played an important role in improving outcomes for smaller children. Evelina London’s transplant surgeons were among the first in the world to pioneer the use of 3D printing to support surgical planning in selected transplant procedures. Such technologies help surgeons better understand anatomical complexity before operating and can support safer, more precise surgery in challenging cases.
Equally important is the evolution of minimally invasive surgical approaches for living donors. Robotic and laparoscopic techniques can reduce recovery times and improve the experience for donors themselves, which is a significant consideration in family-centred transplant programmes.
Into adulthood
However, transplantation is not the end of the journey. Long-term follow-up and ongoing specialist support remain essential throughout childhood and adolescence. Children require careful monitoring and medication management as they transition towards adult services later in life.
One of the great strengths of Evelina London is the close collaboration with adult renal teams at Guy’s and St Thomas’. Transitioning from paediatric to adult care can be a difficult period for young patients with chronic conditions, and maintaining continuity is extremely important. By working closely across both children’s and adult services, we can help ensure that transition is as smooth and supportive as possible.
There is also an increasing recognition that caring for children with chronic kidney disease means supporting the whole family, not just the patient. Parents and carers often carry an enormous emotional and practical burden throughout treatment. Providing psychological support, education and clear communication is therefore a vital part of paediatric transplant care.
Despite the complexity of the work, paediatric transplantation remains one of the most rewarding areas of medicine because of the difference it can make to a child’s future. Seeing children regain energy and begin to enjoy normal childhood experiences again is incredibly powerful for everyone.
Dr Ware is a consultant paediatric nephrologist at Evelina London Children’s Hospital. He has expertise in all aspects of children’s renal medicine. Alongside his colleague Dr Helen Jones, he leads the Evelina London transplant service, one of the largest and busiest children’s kidney transplant units in the UK.
Contact: gstt.privatepatientenquiries@nhs.net
Tel: +44 203 131 6858
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