Casto family shares kidney transplant journey

The Casto family knew the day would come their son Peyton would need a kidney transplant. With a glucose filtration rate of 19 at just 14 months old, they were advised he would need either dialysis or a kidney transplant when he reached a GFR of 10-15. They estimated it likely would be within that same year.

“We first had concerns when he was around 10 months old and was below the first percentile for weight on the growth chart,” mother Erica Casto said. “He had a difficult time starting to eat solid foods and never seemed to have an appetite.”

After trying feeding therapy, a swallow study and thickening of his foods, Peyton Casto still was not growing or gaining weight. He would later be diagnosed by another pediatrician with chronic kidney disease.

Living in the Dayton area at the time, the Castos were referred to the nephrology team at Cincinnati Children’s Hospital and have been followed there ever since.

The story following, though, is much like the story that unfolded Thursday, May 7 on the tennis courts of The College of Wooster.

Peyton Casto, a junior at Orrville High, has the heart of a fighter as he battled his way to a runner-up finish at the NET Championships.

“I was feeling confident that I could win the whole thing, and I am proud of myself for getting to the championship. I was hoping to come away with the victory. I was disappointed for not winning but then remembered all the struggles I had been going through to make it there in the first place. I reminded myself to just be happy with being able to play at all and not be sitting in a hospital bed for the whole day.”

It’s that demeanor that has endeared him to coach Kent Smith.

“So impressive for all he’s been through, and his positive outlook throughout has been so uplifting,” Smith said. “I mean he had to lay off any sports or physical activity for a lengthy time, which meant he wasn’t able to train like he normally would.”

Despite the hurdles, Peyton Casto rose above it all and kept a smile on his face. Coached by the same man who coached his father Matt, he finished the day with 55 career wins, just four shy of matching his father's total wins of 59.

“That’s one of the coolest things is that we both had/have the same coach,” Matt Casto said. “Seeing Peyton do the things that he loves every day, whether that be soccer, basketball, golf and currently tennis, that’s been inspirational.”

Much like he has this school year on the soccer pitch and tennis courts, Peyton Casto battled. In June of the same year of being diagnosed, he received a gastric tube to assist with nutrition. At around 2.5 years old, a more permanent G-tube was placed in his stomach that helped supplement his diet to help him gain weight. With that, Peyton began to gain weight and was able to eat and maintain calories independently with some growth hormone shots from the age of 3-12, and he became more on target with this growth for his age.

Instead of what the doctors predicted would happen, Peyton Casto maintained his GFR until he was 15 years old, and he was advised he would need a transplant.

Much like the family had done initially when he was 2, they went through the process again to test and see if they could donate a kidney to him. The goal ultimately was to have the transplant done prior to doing dialysis because kidney researchers had proven preemptive transplants prior to dialysis saw the kidney last longer. Also, Peyton chose to have the procedure performed as soon as insurance would approve it so it would be less of an interruption to his sports seasons.

“Peyton was tired of being tired,” Erica Casto said. “He would go to school or sports and pretty much sleep the entire evening until the next morning. Anytime he would be sitting still, he would fall asleep.”

Even still, the process took a little longer than anticipated to get approved, with an eye on being back for the fall sports season.

Initially, it was found Matt, Erica and Peyton’s aunt were all potential blood type matches.

“We had so many loving family members and friends that wanted to be tested,” Matt Casto said. “When it finally came time last year to go through the official workup, 14 years after the initial diagnosis, it naturally came with a little bit of anxiety, but very quickly a lot of joy and relief.”

Undergoing a very thorough evaluation where they looked for anatomy, any underlying conditions, and lab work for overall health and kidney function, it was confirmed Matt Casto was the perfect match.

“Finding out my dad was going to be the one to give me a kidney was a relief,” Peyton Casto said. “I knew he was going to be a great donor and would do anything to make sure I had what I needed. So yes, that was a very special moment for me.”

As for finding out he would need the procedure, it hit hard for the young man.

“When they gave me the news that I would need a transplant last year, I was insanely nervous and scared,” Peyton Casto said. “I knew that my life was going to change enormously, and I would have a very hard time getting back to normal. I didn’t know what getting a transplant all entailed, but either way, I knew it was going to be tough.”

Through all of that, his father couldn’t have been happier to be the one donating to his son.

“For all the anxiety prior, it was quickly replaced with joy and a blessing of being able to donate,” Matt Casto said. “Also, it was relieving that Peyton would be able to move forward with the transplant without having to have dialysis or other treatments.”

After a few days in the hospital, Matt Casto was able to see Peyton shortly after he returned from surgery.

“The nephrology medical team at Cincinnati Children’s has been an amazing partner in Peyton’s care throughout his childhood,” Matt Casto said. “They will forever be a group of heroes to our family as Peyton continues to improve his quality of life as a young man with a wise and experienced kidney.”

As for his role in his own son’s new lease on life.

“It has been a blessing and answered prayers beyond any expectations to have had the chance to give Peyton a better life and future,” Matt Casto said. “But I was just a small part of the bigger team and family that makes things like this possible. Experiences in life are transformational, and this experience has personally given me a new perspective while also helping our family grow stronger and more resilient.

"We know well that anything is possible when we come together with a common goal. Peyton and his brothers know that they do hard things.”

Not wasting time, not long after his procedure, Peyton Casto pushed through his recovery and rehab, working extremely hard to meet and surpass all physical goals that his transplant team gave him. Spending extra time in therapy, going to the gym and meeting his water goals, he developed the discipline and daily routines for his extensive daily medications.

Just 41 days after his transplant Aug. 12, 2025, Peyton Casto was back playing sports when he returned to the soccer pitch Sept. 22.

“Returning to soccer, there was so much anxiety with all the pushing, rolling and contact, but he adjusted quickly,” Erica Casto said. “He has never been afraid to get involved in anything.”

In the months following, Peyton Casto chose to play for the Cagers in basketball while he built up his endurance with hopes to play for his high school in his senior year. The highlight on the hardwood came when he scored 17 points in a game and also helped the Cagers beat Kingsway Christian, a state-qualifying team.

“I'm feeling good and slowly getting better every day,” Peyton Casto said. “The recovery was definitely a struggle, but I saw improvements every day. The hardest parts were not being able to go to school for six weeks, as I am usually always out doing things with my friends. Slowly, I got to play soccer again with limitations, played club basketball and now tennis. I wasn’t playing very well to start; however, as the season got going, I started to play like myself again, and now at the end, I feel like I am playing at almost full capacity, which I am very proud of.”

“My husband, though nervous, recovered quickly and has had no complications,” Erica Casto said. “There were joyful tears at the surgery’s success and them both doing well. Transplant, though a blessing, is still a form of treatment and something he will be constantly monitoring for the rest of his life. We are absolutely closer as a family, and our struggles, they make us stronger.

“We truly believe we all are given one life and to make the most of every moment. We just want to say thank you to our community and his sporting teammates who have supported us throughout this process.”